Letter to the Editor: Assessing the Long-Term Potential of Relaxing Regulations: Should We Go Back to Business as Usual?

The novel coronavirus SARS-CoV-2 (COVID-19) strain has resulted in a pandemic affecting many countries and health care systems globally. In the United States, the Secretary of Health and Human Services (HHS) declared a public health emergency on January 31, 2020. ¹ On March 13, 2020 an emergency declaration for all states was issued increasing the federal support to HHS. ² Since then federal, state, and local governments have loosened many regulatory parameters related to health care delivery. ² Their intentions are to improve efficiencies, reallocate workloads, and remove barriers to delivering expedited care to those in need. Is there a chance to learn from this experience and potentially flatten the postpandemic health care expenditure curve?

A recent report from the Organization for Economic Co-operation and Development (OECD) revealed that the United States devote ∼17% of its gross domestic product (GDP) to health care. This is the highest spent among all OECD countries and twice as high compared with the average health care spending. ³ Similar findings are reported when the health care spending per capita is calculated ($10,586 in US versus $5,287 average in other wealthy developed countries). The Centers for Medicare and Medicaid Services (CMS) project that in less than a decade the health care cost will represent ∼20% of the GDP. ⁴ Although there are many reasons that can explain this increased health care cost, a big part of it could be attributed to the administrative cost that derives from the inefficiencies and complexity of the U.S. health care system. In the United States, the administrative cost per capita is calculated to be ∼$850, nearly five times more than that average of other wealthy developed countries. It is clear that during the COVID-19 emergency, loosening regulations across health care has helped remove obstacles in delivering health care. This unique moment in history is an opportunity to reexamine the considerable presence of these regulations in our health care system.

Licensing and specialized credentialing for physicians, advanced practice providers (APPs), and nurses^5,6 were among the initial regulatory parameters to be loosened at the onset of the pandemic. The intention is to allow specialized medical professionals to return to the general delivery of health care to those in need. The Emergency Management Assistance Compact allows licensing reciprocity across all 50 states. Structures behind APPs limitations have also been relaxed giving them the opportunity to attend to patients regardless of their primary clinical focus. Hospital systems, as well as state level employees, work yearly to monitor and maintain these normally strict parameters.

Various bodies that accredit programmatic centers of excellence have also paused on their nonpatient facing resources deadlines and expectations. The Joint Commission has suspended on-site inspections ⁷ and programs such as the American College of Surgeons Committee on Trauma (ACS COT) and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), among others, have been offered delayed regulatory inspections and annual visits. Although data collection and process improvement efforts for these programs are still in place, the postponement of all routine surveillance facility inspections has allowed health care systems to focus on developing emergency plans for the management of COVID-19 patients' surge.

In addition, the CMS relaxed the measurement and impact of the 2% payment withholds correlated with patient experience and other quality metrics for health care delivery systems. This action alone allowed innumerous resources usually dedicated to the gathering and analytics of data to be refocused on direct patient care.

Hospital systems across the country dedicate innumerous resources to these myriad regulatory guidelines that are “usually” in place. Observing the benefit these resources bring to health care delivery in the moment when these expectations are loosened has been eye opening. With so many resources currently within our health care system, which are not directly delivering care, it is no wonder our overall health care expenditures continue to rise. Could the loosening of these expectations in a more permanent way help reduce costs? Are there other areas to consider for similar opportunities? Before we go back to business as usual, this is a decisive moment to assess what is truly adding value to our health care systems.