Verma: CMS efforts have reduced provider burden to all-time low

It’s been two years since the Centers for Medicare and Medicaid Services launched an effort to ensure providers spend less time on administrative tasks and more time with patients.

Now, CMS contends it has achieved unprecedented success in that aim.

In 2017, the agency launched its Patients Over Paperwork initiative in an attempt to improve the healthcare delivery system by reducing unnecessary burdens for clinicians.

“We have searched high and low for duplicative, unnecessary or excessively costly requirements,” said CMS Administrator Seema Verma at an agency event on Tuesday highlighting its accomplishments over the past two years. “This effort was driven by the conviction that reams of prescriptive government regulations that dictate processes for the health system have failed.”

“While there’s much more to be done, we’ve made considerable inroads,” Verma claimed, adding that provider burden is at “an all-time low.” Overall, she said that CMS’s burden-reduction efforts will save $6.6 billion and 42 million burden hours through 2021.

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Seema Verma, administrator of the Centers for Medicare & Medicaid Services, speaks during a 'Conversations with the Women of America' event at the Eisenhower Executive Office Building in Washington, D.C., U.S., on Tuesday, Jan. 16, 2018. Republican leaders in Congress are angling for another short-term funding measure to avert a government shutdown at the end of this week while trying to keep a dispute over immigration separate from their attempts to get agreement on spending priorities. Photographer: Al Drago/Bloomberg

Verma cited a recent study that showed that $266 billion annually—the largest source of waste in U.S. healthcare—can be attributed to administrative costs. She noted that CMS launched the Patients Over Paperwork initiative to “right the ship” and “get rid of outdated regulations that don’t make sense.”

According to Verma, the agency has “eased provider burden, reduced administrative costs and put patients first,” thanks to its efforts including coding and documentation requirements for Medicare payment.

“Last year, we made historic proposals to simplify how doctors document evaluation and management codes used to bill Medicare—and, those codes have been in place for over 20 years. And, we’re continuing that work this year.”

Evaluation and management coding is the process by which physician-patient encounters are translated into five-digit Current Procedural Terminology (CPT) codes, which are submitted for payment.

At Tuesday’s CMS event, Barbara Levy, MD, represented the American Medical Association and praised the Patients Over Paperwork initiative.

“We’re really thrilled to be partners with CMS in forwarding this initiative to reduce burden on healthcare providers,” said Levy, co-chair of the AMA’s CPT/RUC Evaluation and Management Workgroup. “For years, the physician community has struggled with burdensome guidelines for reporting evaluation and management services. In 2018, under Seema Verma’s leadership, CMS provided the first opportunity to achieve real burden relief on E&M for American physicians.”

Levy added that CMS is still engaged in rulemaking, but AMA is hopeful that the agency will fully implement the CPT/RUC Evaluation and Management Workgroup’s recommendations. “We need to be freed of the excessive administrative burdens so that we can devote that time to patient care,” she said. “The AMA strongly supports Administrator Verma and the Patients Over Paperwork initiative.”

When it comes to health IT, Verma pointed out that CMS has “increased flexibility for medical students to put information into the electronic health record (to) make it easier for teaching physicians to train the next generation of doctors.” She said the agency has proposals to “extend this policy to other clinical teachers like physician assistants and nurse practitioners.”

In response, Janis Orlowski, chief health care officer for the Association of American Medical Colleges, thanked Verma and said AAMC strongly supports the Patients Over Paperwork initiative, including “allowing teaching physicians to verify in the medical records any student documentation of billable E&M services—rather than requiring the attending physician to re-document the work.”

Verma noted that CMS is also tackling the challenging issue of prior authorization as part of its Patients Over Paperwork initiative to reduce administrative burdens in healthcare. “Prior authorization is particularly important to us,” she emphasized.

Towards that end, Verma said CMS is continuing its support for the Da Vinci Project, a payer-provider led effort to leverage HL7’s Fast Healthcare Interoperability Resources (FHIR) to exchange critical data required for value-based care delivery.

The Da Vinci Project is “a private sector initiative focused on integrating value-based data exchange to help streamline access to coverage requirements,” she said.

However, last month, more than 100 physician organizations—led by the American Medical Association—sent a letter to CMS expressing “strong concerns” that the agency may be too focused on automation as the “only vehicle” for implementing prior authorization (PA) reforms.

“We are aware that CMS has invested heavily in the Da Vinci Project, which leverages technology to facilitate electronic exchange of clinical data by extracting information from physicians’ electronic health records,” stated the letter to Verma. “While Da Vinci holds promise, there are a series of issues with exclusively relying on technology to address the burdens of PA.”

The medical societies charged in their letter that the Da Vinci Project “will allow payers unprecedented access to EHRs” and that “protections are needed to prevent plans from inappropriately accessing patient information, coercing physicians into using technology (e.g., through contracts), or interfering with medical decision making.”

Further, the physician groups contend that the Da Vinci Project “represents nascent technologies that have yet to be widely implemented” and, as a result, “the costs and the timeframe availability across EHR vendors remain unclear.”

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