Patients over paperwork: Medicare has delivered lower costs and regulatory relief for health care providers

The COVID-19 public health emergency has highlighted that government rules and regulations should not hinder providers from delivering high-quality care to patients.  The Trump Administration exhibited an understanding of this principle long before the pandemic when it announced the Cut the Red Tape initiative in 2017. With a healthcare system marked by $200 billion in annual administrative costs that contributes to higher costs for patients and a bureaucratic system that forces doctors to spend more time with paperwork than with patients, the Centers for Medicare and Medicaid Services launched the Patients over Paperwork initiative to get rid of outdated, burdensome regulations that thwart innovation and inflate prices.

Over the last three years, CMS has sought public input through listening sessions, observational site visits, and requests for information. We’ve combed through our regulations to eliminate burdensome policies, simplify documentation requirements, and focus on meaningful quality and health outcomes measures.  Informed by feedback from over 3000 providers and 15,000 public comments, scores of actions have reduced the burden across all types of providers and better recognize the value of providers spending time with their patients.

Whether it’s replacing outdated quality measures governing organ procurement and transplantation to maximize organs available to save lives, or streamlining reporting requirements that reduce administrative costs or modernizing Medicare rules for innovators to ensure beneficiaries have access to the latest technologies, all our efforts are designed to make the healthcare system more efficient.

One area that I’m especially proud of is our efforts to alleviate the regulatory burden for clinicians, who are the foundation of our healthcare system.  Previous administrations issued thousands of pages of regulations that have saddled clinicians with more paperwork and have forced them to spend too much time in front of a computer screen instead of at the bedside. These and other administrative burdens have contributed to physician burnout, or moral injury, and a growing number of physicians have hung up their white coats or even sold their independent practices to large hospitals. To truly transform our healthcare system into one that rewards high-quality care, we are getting the government out of the way of the clinicians who create clinical value that benefits patients.

When we heard from physicians that reporting on numerous CMS-mandated quality reporting measures was arduous and ineffective, we overhauled and improved how we measure quality- eliminating dozens of redundant and outdated quality measures with projected savings of $128 million and an anticipated reduction of 3.3 million burden hours through 2020. We also revamped our MIPS Value Pathways framework (or our clinician pay-for-performance program) that will help ensure that clinicians are evaluated based on measures that are relevant to their specialty and made it easier for them to performance data.

We’ve proposed updates, after thirty years, to our physician self-referral rules, also known as the “Stark Law,” to remove impediments for physicians to provide care coordination, a crucial component for physicians to engage in value-based care.

Finally, we eased the billing and paperwork requirements for clinicians for the first time in nearly twenty years.  Starting this January, we are adopting changes recommended by the American Medical Association to give clinicians greater flexibility, reducing time spent on paperwork by an estimated two million hours annually.

All told, Patients over Paperwork has saved the medical community $6.6 billion and 42 million burden hours through 2021. That’s more time and money for providers to spend on patients. And we are not done. We’ve created an Office of Burden Reduction, tasked with embedding this culture throughout CMS and across all the programs we run.

When the COVID-19 public health emergency struck, CMS was able to accelerate our ongoing efforts to reduce regulatory burden to help front line healthcare workers respond to the pandemic. With postponing elective procedures and patients advised to stay at home to avoid exposure to the virus, CMS quickly expanded Medicare telehealth, making it easier for clinicians to maintain access to care for their patients. As hospital capacity reached its limit, we reduced detailed paperwork requirements making it easier to discharge patients more quickly across care settings while maintaining our focus on patient safety and quality of care. We provided temporary relief from many audit and reporting requirements by extending reporting deadlines and documentation requests so that providers can focus on providing needed care to patients.  These historic policies extended a lifeline to a healthcare system stretched to its breaking point and call into question whether many of these requirements should be retired permanently. We are working through the specifics now, but one thing is certain: The Trump Administration is committed to upending the status quo to get rid of unnecessary administrative burdens and costs that make it easier for providers to deliver care and ultimately allows patients to receive higher quality care at lower costs.

Seema Verma is administrator, Centers for Medicare and Medicaid Services.

Image credit: Shutterstock.com

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