America’s physicians are spending too much time as data entry clerks focused on “burdensome and often mindless” administrative tasks that are distracting them from direct patient care, a serious problem in healthcare that the Centers for Medicare and Medicaid Services is taking steps to address.
That’s the message CMS Administrator Seema Verma delivered to physicians on Monday in a “Dear Doctor” letter sent to various clinician groups.
“From reporting on measures that demand that you follow complicated and redundant processes, to documenting lines of text that add no value to a patient’s medical record, to hunting down records and faxes from other physicians and sifting through them, wasteful tasks are draining energy and taking time away from patients,” wrote Verma. “Our system has taken our most brilliant students and put them to work clicking through screens and copying and pasting. We have arrived at the point where today’s physicians are burning out, retiring early, or even second-guessing their decision to go into medicine.”
To protect the doctor-patient relationship, she noted that CMS late last week released a proposed rule for the Calendar Year 2019 Physician Fee Schedule designed to reduce overly burdensome regulations on providers. Part of the agency’s Patients Over Paperwork initiative, the CMS proposal is an attempt to streamline documentation requirements and modernizing Medicare payment policies.
In particular, the agency has set its sights on reducing the burden of Evaluation and Management (E&M) codes on physicians, who are required to document specific types of information in patients’ medical charts. According to Verma, E and M visits represent 40 percent of all charges for Medicare physician payment and proposed changes to the documentation requirements for these codes will have far-reaching impact.
“We believe that you should be able to focus on delivering care to patients, not sitting in front of a computer screen,” added Verma. “Washington is to blame for many of the frustrations with the current system, as policies that have been put forth as solutions either have not worked or have moved us in the opposite direction. Electronic health records were supposed to make it easier for you to record notes, and the government spent $30 billion to encourage their uptake. But the inability to exchange records between systems—and the increasing requirements for information that must be documented—has turned this tool into a serious distraction from patient care.”
Verma pointed out that the current system of E and M codes includes five levels for office visits, with Level 1 primarily used by non-physician practitioners and Levels 2 through 5 used by physicians and other practitioners.
“We’ve proposed to move from a system with separate documentation requirements for each of the four levels that physicians use to a system with just one set of requirements, and one payment level each for new and established patients,” she concluded. “Most specialties would see changes in their overall Medicare payments in the range of 1 to 2 percent up or down from this policy, but we believe that any small negative payment adjustments would be outweighed by the significant reduction in documentation burden. If you add up the amount of time saved for clinicians across America in one year from our proposal, it would come to more than 500 years of additional time available for patient care.”
In a written statement, America’s Physician Groups said it is still “digesting” and reviewing the proposed CMs rule to see how it potentially impacts its membership, which includes 300 medical groups and independent practice associations across the country.
However, APG noted that the agency’s proposal provides “major reforms” to E and M payments through “single blended payment rates for both new and established patients” for office and outpatient Level 2 through 5 visits, as well as a “series of add-on codes to reflect resources involved in providing complex primary care and non-procedural services.”
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