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Rural hospital leaders today made their case for regulatory relief from federal policies – like the 96-hour physician certification requirement, direct physician supervision of outpatient therapeutic services and interoperability standards for health information technology – at a briefing on Capitol Hill. The 96-hour physician certification requirement as a condition for reimbursing critical access hospitals “shifts our focus from patient needs and quality to meeting regulatory needs … and takes decisions about patient care out of the hands of the doctor,” said Susan Starling, president and CEO of Marcum & Wallace Memorial Hospital in Irvine, KY. “How do you explain to an 85-year-old patient who is sick that they are being transferred out of their community for hospitalization … away from their family, home and support system all because of a regulation?” Christina Campos, CEO of 10-bed Guadalupe Hospital in Santa Rosa, NM, took aim at the direct supervision policy for requiring physicians to perform routine outpatient therapeutic services. “Everybody is asking for something more, whether it’s electronic medical records or the 96-hour rule or direct supervision,” she noted. “We feel like we are dying a death of a million paper cuts.” Montana Hospital Association President Dick Brown said one of the biggest challenges is “getting [the Centers for Medicare & Medicaid Services] to acknowledge the realities of rural health care and move forward with innovative solutions. Rural states need the opportunity to continue to grow their own health care programs by exploring options through demonstrations. That means we need the flexibility to experiment with new ways of providing health care.” The panelists also urged Congress to pass important rural legislation, including the Critical Access Hospital Relief Act (H.R. 169/S. 258) and the Protecting Access to Rural Therapy Services Act (H.R. 1611/S. 257).