Tuesday, October 31, 2017

Before Patients Over Paperwork, there was Patients Before Paperwork

The Centers for Medicare and Medicaid Services’ (CMS) new initiative to reduce the paperwork burden on doctors and patients, deemed Patients Over Paperwork, is remarkably similar to ACP’s campaign, called Patients Before Paperwork, to accomplish the same.   Whether the agency was directly inspired by ACP’s campaign, down to coming up with an almost identical name for it, or came up with a similar moniker on its own, what matters is that the message ACP has been pushing for more than two years now, that doctors are being squeezed by unnecessary administrative tasks that take time away from patients, is being heard now at the highest reaches of the federal government.  What I do know is that prior to CMS’ launch of the initiative last week, ACP has held several meetings with and previously wrote to CMS officials pressing our recommendations to reduce unnecessary regulations and other administrative tasks. 

In her remarks yesterday to the Health Care Learning and Action Network Fall Summit, CMS Administrator Seema Verma explained what CMS hopes to accomplish from Patients Over Paperwork:

Since assuming my role at CMS, we are moving the agency to focus on patients first. To do this, one of our top priorities is to ease regulatory burden that is destroying the doctor-patient relationship. We want doctors to be able to deliver the best quality care to their patients. 

We often hear about this term – “regulatory burden” – but what does it actually mean? Regulations have their place and are important to ensuring quality, integrity, and safety in our health care system. But, if rules are misguided, outdated, or are too complex, they can have a suffocating effect on health care delivery by shifting the focus of providers away from the patient and toward unnecessary paperwork, and ultimately increase the cost of care. 

I saw this during a recent trip to Hartford, Connecticut, where I met with providers.

One told me she was going to close her practice after decades in medicine because spending so much time away from her patients doing paperwork just wasn’t worth it for her anymore. 

In Cleveland, Ohio, I heard a story of a physician who was overwhelmed by having to personally fax patient records…in 2017 we are still faxing patient records. Just thinking about that frustrates me…having to do it, I’m sure is even worse. 

Doctors are frustrated because they got into medicine to help their patients. But, paperwork has distracted them from caring for their patients, who often have waited weeks, if not months, for the brief opportunity to see them. 

We have all felt this squeeze in the doctor’s office…we have all seen our doctors looking at a computer screen instead of us. I hear it from patients across the country. This must change.

The primary focus of a patient visit must be the patient. Just last week, CMS announced our new initiative “Patients Over Paperwork” to address regulatory burden. This is an effort to go through all of our regulations to reduce burden. Because when burdensome regulations no longer advance the goal of patients first, we must improve or eliminate them.   

At CMS, our overall vision is to reinvent the agency to put patients first. We want to partner with patients, providers, payers, and others to achieve this goal. We aim to be responsive to the needs of those we serve. We can’t do that if we’re simply telling our partners what to do—instead of listening and—most importantly—having our policies be guided by those on the 
front lines serving patients. 

Touche!  ACP couldn’t have said it better.  Today, we sent a letter to Administrator Verma to pledge our support for her Patients Over Paperwork initiativeWe shared with her our policy paper, Putting Patients First By Reducing Administrative Tasks in Health Care, which proposes an entirely new framework to evaluate the intent and impact of existing or proposed new tasks, so that those that are not justified by their intent, or that have such an adverse impact on doctors and patients that they cannot be justified even if the original intent is sound, can be challenged and then eliminated or at least ameliorated.  We urged that CMS adopt this framework to evaluate its own regulations and administrative tasks.

ACP’s letter also advised her that we were encouraged by her announcement of a new “Meaningful Measures” initiative to ensure that quality measures, which are a critical component of paying for value, are streamlined, outcomes-based, and truly meaningful to clinicians and their patients.  This initiative appears to be well aligned with ACP's comments to CMS last year on the Quality Measure Development Plan. 

Whether it is putting patients before or above paperwork—both are needed—it is great news for doctors that ACP’s two-year plus campaign to reduce administrative tasks on physicians has found support in the highest reaches of government, coming from the head of an agency, CMS, that can do more to ease red tape than any other. 

Today’s question: if you were CMS Administrator Verma, what is the first Medicare administrative task you would recommend she review?


DrJHO7 said...

Well, there's the EHR...
But that's not really paper, is it?
Is it time away from the patient, or time away from everything else in your life that's the issue for the physician (now referred to as "provider")?
Oh, but be resilient, don't get burned out.
I think the biggest drag was the 1-2 hours of completion of electronic documentation at the end of each day (every evening). That, of course, was in addition to usual end of the day tasks like review of test results, calling patients about them and responding to questions and other phone calls. Of course we try to do as many of these things during the day as we can, and involve our staff as much as possible. Was.
Yes, paperwork is a problem, there's too much of it, and much of it is a redundant, pointless, waste of time. But the burden of electronic documentation on physicians - that needs a different solution, perhaps "happy patients and physicians before hyper-documentation", or some such phrase.
Here's a potential solution: the physician's progress note should only state what needs to be stated, nothing more, nothing less. It also shouldn't exclude important information. Important to the physician. Not to some government contractor who does RACC auditing.
It would follow that, payment of physicians for their time and effort and expertise needs to change in a way that doesn't overemphasize some non-physician bean counter's idea of what a physician progress note should look like.

Unknown said...

Face to face requirements! This is unduly burdensome to a number of us.

southern doc said...

"quality measures, which are a critical component of paying for value"

In addition to, by its very nature, being expensive to administer and crushingly bureaucratic, there is no evidence that so-called value based payment reduces costs or improves outcomes.

We still don't understand why the ACP supports it.

Unknown said...

I think we all have those days when we feel we are documenting for billing rather than to toward some meangful data that reflects how we take care of patients - this has to change - the amount of documentation needed to satisfy some nonhealth care entity making sure there’s appropriate notes for a level code for reimbursement takes the pleasure away from practicing medicine
The idea behind hours of prior authorization for a referral is a new burden in the making . I understand the need to send a referral over to the specialist but thereafter the staff have to get on the phone to get an authorization from the insurance so patient can be seen!!!What is the purpose of this regulatory burden?? We don’t send patients to specialist ad hoc but do so because the patient needs expertise of which I have run out!!!someone needs to look into this to stop this utter waste of time and effort!

southern doc said...

The true evil behind the ACP's beloved value based payment schemes:


You're choosing to run with some very bad people here.