Jun 10, 2019

When It Comes To Our Health – Every Second Counts

Seema Verma
Administrator, Centers for Medicare & Medicaid Services

When It Comes To Our Health – Every Second Counts

Health care: American’s favorite debate topic.  While there is much to debate, we can all agree that the patient-provider relationship has been strained by unnecessary regulations and reporting requirements. Too much regulation has had the unintentional result of putting the government first and the patient second.  Time spent on adhering to these regulations has decreased the amount of time clinicians spend with patients.

Our health care system is big and complex and when you add numerous government regulations on top of it, the result is that government becomes a barrier to patient empowerment, innovation and competition. The focus shifts away from patients and on to micromanaging systems, regulating processes, and reporting. The resulting complexity has become unwieldy, increased costs, reduced patient interactions, and contributed to clinician burnout.

We all know that physicians’ training in particular is long, tough and continues throughout their career. There are very few professions that require this much expertise. Yet, it is often the case that these highly trained men and women spend more time checking boxes and filing paperwork than practicing medicine and caring for patients. 

Anyone who has needed medical assistance can attest to the fact that it wasn’t their insurance or a government regulation that had the most impact on their health. It was the medical professional caring for them – the clinician’s skill, dedication, compassion, and training – and the time spent with the clinician – that determined the quality of care received. This is why at the Centers for Medicare and Medicaid Services (CMS), following the leadership of the President’s “Cut the Red Tape” initiative, we created the Patients over Paperwork initiative to eliminate outdated, duplicative, and overly burdensome regulations so clinicians and providers can focus on their primary mission: patient care.

And I am very proud of our progress so far. Over the past two years we made a concerted effort to reduce clinician and provider burden.  We worked across multiple CMS programs to reduce burden through regulatory changes, documentation simplification, and policy updates.

According to our latest information, savings to providers and clinicians are estimated at $5.7 billion and 40 million burden hours through 2021. Estimated savings come from both final and proposed rules. This includes the elimination of 79 overly burdensome, redundant, or low-value measures for a projected savings of $128 million and anticipated reduction of 3.3 million burden hours through 2020. 

This is a huge accomplishment, and it was a team effort. Over the last two years, we were able to identify burdensome regulations by soliciting feedback from the medical and patient communities through requests for information, listening sessions, and onsite engagements with front-line clinicians, staff, and patients.  To date, we addressed or are in the process of addressing 83% of the actionable areas of burden identified through the 2017 RFI. We also heard from over 2,000 customers across 23 states through interviews, listening sessions and onsite visits to health care facilities, practices and beneficiary homes.  

Using the information we gained from our intensive outreach, we made common-sense changes, such as allowing patient notes written by medical students to count for billing purposes when the supervising clinician signs off, and allowing clinicians to focus their notes on what had changed since the last time they saw a patient.

Most recently we made changes to the Medicare appeals process in an effort to reduce burden and simplify processes. Specifically we streamlined the appeals process that Medicare beneficiaries, providers, and suppliers must follow to appeal denials. We anticipate saving providers approximately 74,000 hours and $3.4 million per year, with most savings coming from removing the requirement that providers must sign appeal requests. We also finalized a number of technical corrections to remove outdated and redundant terminology, and adopted additional changes to further reduce regulatory burden and make it easier for beneficiaries and providers to navigate the appeals process.

We’ve been working hard to reduce burden through sub-regulatory changes. We heard that the local coverage process is an important means to provide decisions on items and services that benefit Medicare’s beneficiaries but we also heard about a number of concerns around transparency and notifications.  We listened and, in response to these concerns and to Congress’ requirement in the 21st Century Cures Act for more transparency in the LCD process, made eleven updates to modernize and reduce burden related to LCDs. In addition, CMS also continues to work with providers and clinicians to modernize documentation requirements and billing codes—which in turn will free up more time for patients, lessen clinician burnout, and bolster the doctor-patient relationship. To date we have made 13 documentation changes.

While we’ve made great strides, our work isn’t done. We continue listening to providers, clinicians, and patients through our Patients over Paperwork email address: PatientsoverPaperwork@cms.hhs.gov.

Last week we issued The Request for Information on Reducing Administrative Burden to put Patients over Paperwork. The RFI invites patients and their families, the medical community, and other healthcare stakeholders to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our healthcare system’s resources from needless paperwork to high-quality care that improves patient health. Comments are due August 12, 2019 and can be submitted here: https://www.federalregister.gov/documents/2019/06/11/2019-12215/request-for-information-reducing-administrative-burden-to-put-patients-over-paperwork.

We will never stop looking for ways to make our regulations more streamlined and focused on results, because when it comes to the health of our patients, every second counts.

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