Remarks by Administrator Seema Verma about the Burden Reduction Proposed Rule
(As prepared for delivery – September 17, 2018)
Good Morning everyone, and thank you for being here. Special thanks to Dr. Gregory Argyros, CEO of MedStar Washington Hospital Center, for hosting us at this beautiful hospital, and Rick Pollack, President and CEO from the American Hospital Association for joining us.
Before we get started, I do want to take some time to talk about what’s currently happening along the east coast, as a result of Hurricane Florence.
For those of you that may not know, following a natural disaster, CMS works diligently with HHS and FEMA to make sure that our beneficiaries have access to the care they need and we work with providers on the ground to make sure that regulations don’t get in the way of providing critical care to patients.
We also track our beneficiaries with special needs such as those who require oxygen or dialysis to be sure they are getting the care they need even in the midst of these storms. We have issued a number of waivers in VA, NC and SC around deadlines, quality reporting and certification requirements. Our teams are working around the clock and will continue to do so as long as needed.
As many of you know, upon taking office, President Trump made reducing burdensome regulations across the federal government a top priority, establishing his Cut The Red Tape Initiative. At CMS, we took this directive and created our Patients Over Paperwork Initiative last year and today I want to highlight some of our key accomplishments as well as make a new announcement.
And Rick, I know that the topic of burden reduction on providers is something that the AHA has been working on a very long time as well, and you have been a great partner to us in finding ways to reduce provider burden while still ensuring and even increasing program integrity, high quality patient care and patient safety.
Let me first say that regulations are important and critical to patient safety, quality and program integrity. And providers count on them to guide their processes. For example, CMS conditions of participation require providers to have processes in place to guide them in times of disaster and to ensure patient safety, which are very relevant today as providers in NC, SC, and VA will hopefully be better prepared to keep patients safe.
But we all know that at times regulations can get in the way of innovation and can actually drive up costs, and the rising costs of our healthcare system are unsustainable. By 2026 one in every five dollars spent in our economy will be on healthcare. For government, this means that healthcare spending will crowd out funding for other priorities like national defense, education, public safety, and infrastructure. For businesses this means that they will no longer be able to invest in growth or create jobs, and for all of us this means that our household budgets will be stretched even further because of higher premiums and copays.
The United States has the best healthcare delivery system in the world and we must keep it that way. The answer is not to ration care, or limit access. But to continue to innovate, reduce inefficiency and to drive to a system that delivers value, one that delivers high quality care and better outcomes for patients at the lowest possible cost. This is a high priority for Secretary Azar and CMS is focused on doing our part and removing barriers to delivering value.
To that end, as I mentioned at the beginning of my remarks, President Trump directed the entire administration to find ways to cut unnecessary and overly burdensome regulations. CMS was one of the biggest culprits. CMS produces around 11,000 pages of regulations per year. There are scores of studies that document the cost of regulations for hospitals and doctors.
Having come to CMS from the front-lines of our healthcare delivery system, I knew that it was important from us to hear from those living under our regulations to see which ones were valuable and which ones were redundant, topped out, or weren’t positively impacting patient care, patient safety, or program integrity, so we met with providers, beneficiaries, family members, caretakers, and healthcare professionals to inform our actions. I traveled across the nation to meet with providers from rural areas and urban. In total, the CMS team conducted 21 site visits, nearly 300 customer interviews, 97 subject matter expert interviews, and held 73 listening sessions around the country. We also asked stakeholders, through a series RFIs, to send us their ideas on how we can reduce burden, and we received over 2,800 comments that we have been going through with a fine tooth comb to find any way we can reduce regulations and improve patient care.
We sent our staff that writes the regulations directly to the facilities that were impacted by the rules, to go and see how the regulations come together and impact patient care and operations. Our teams were thrilled to do this, they reported learning a lot and I think it really opened their eyes.
CMS listened and what we heard was that, not only were many of our regulations not contributing to improving patient health outcomes, or improving quality of care and patient safety, but instead many of them were actually having a negative effect: keeping patients from the care that they need and decreasing patient safety by taking providers away from caring for their patients.
Given this feedback, CMS responded. Specifically we heard that many of our quality measurements weren’t meaningful in actually measuring quality, so as a part of the Patients Over Paperwork Initiative, we revamped our quality measurements, and have called our new program Meaningful Measurements.
We heard complaints about the Stark Law, EHRs, interoperability and E&M codes. We issued an RFI on Stark and we plan to revise our regulations, hopefully this year. We have made it clear that patients own their medical record and have made significant changes to make interoperability of the healthcare system a reality. CMS has also proposed the most comprehensive reform of E/M coding since its inception. We have also awarded new Recovery Audit Contracts, or RAC audits, streamlining the review process and documentation requirements.
And today, I am pleased to announce we are proposing a new rule that will make changes across the health care delivery system from hospitals, to surgery centers, transplants center, hospices, mental health centers and many more. Today’s rule is intended to ease the burden of regulation, while ensuring that we maintain a focus on integrity, quality and safety.
We have made many changes to the regulations, and while I won’t get into too much detail, I do want to highlight some key provisions of this proposal, namely the increased efficiency to support patients who need organ transplants. Many Americans know that waiting for a transplant can be one of the hardest times, not only for the patient in need, but for their friends and family. Unfortunately, much of that wait is due to unnecessary regulations that create inefficiencies and put lives in danger. We are proposing to remove those inefficiencies to reduce the amount of time patients have to wait, so that they can begin healing. We are doing this, while still maintaining other requirements in order to continue to monitor and assess outcomes and quality of care in transplant programs after initial Medicare approval.
Other key elements of our proposal include streamlining hospital outpatient and ambulatory surgical center requirements so that doctors can determine what information is necessary for each patient. We are proposing to allow multi-hospital systems to have a unified and integrated Quality Assessment and Performance Improvement system program for all of their hospitals and we are simplifying the ordering process for portable x-rays and modernizing the personnel requirements for portable x-ray technologists in order to increase their availability.
Today’s rule would produce an additional $1.12 billion in savings every year, on top of savings already achieved as part of the Patients Over Paperwork initiative that we started last year. Between 2018 and 2021, CMS now projects the Patients Over Paperwork initiative to eliminate more than 53 million hours of burden for providers and save our healthcare system close to $5.2 billion.
Our work is not done, we are still soliciting ideas. I appreciate the work that Congress has done in working with us to find ways to reduce burden on providers while maintaining quality of care for patients. I particularly want to recognize the work of our authorizing Committees – Senate Finance, House Ways and Means, and House Energy and Commerce – who have been with us every step of the way on this initiative.
And, for the continued support from healthcare stakeholders, like our partners here from the AHA, and others represented in the audience that are working on the front lines and have been great partners in identifying opportunities for efficiency.
I thank the President, for his leadership and commitment to reducing regulations. And Secretary Azar’s commitment to moving our healthcare system towards providing value for patients. CMS will continue our efforts to eliminate unnecessary regulations that take providers away from patients and stifle innovation. Every hour saved from reducing needless administrative burden is an hour more that our healthcare system can spend improving Americans’ health outcomes, and every needless requirement we eliminate saves patients and taxpayers money.
It should be clear to everyone that these aren’t just words to us, but that this administration takes seriously our responsibility to modernize the Medicare program to serve our beneficiaries better, and through the size and influence of Medicare, improve the whole healthcare delivery system to provide value for every American.