Patients Over Paperwork Initiative Update

The Patients Over Paperwork initiative recently celebrated its two-year anniversary. Seema Verma and several others provided updates on the progress of the program on October 30th, 2019.

This has been a top priority for CMS Administrator Seema Verma. The goal is to ensure quality care while removing much of the redundant and duplicative “red tape.” CMS has actively engaged the community at large through an RFI back in 2017, and another one this past August, to better understand the regulatory obstacles that have created for providers in taking care of patients.

The results of the RFI two years ago indicated over 3,000 data points and 1,100 issues. To date over 80% of those 1,100 identified issues that fall under the jurisdiction of the administration and this initiative have been addressed. The more recent RFI (August) identified another 500 issues that will be tackled in the coming months. As a part of the RFI, There were 102 listening sessions as part of the RFI process, which were critical for CMS to hear and understand the struggles from the front lines.

The following are key milestones and updates from the Patients over Paperwork initiative:

  • Stark Law Revision Proposal released (est. savings of $800M).
  • Proposed Rule for Nursing Home administrative burden released (estimated savings of $616M).
  • Physician Burnout Research and Initiatives
    • E&M reform in collaboration with the AMA
    • Current system has been in place for over 20 years (’95 & ’97 Guidelines)
    • Allowing teaching physicians flexibility to review and accept student and resident EHR data entry
    • Establishing new guidelines for physician assistant and nurse practitioner EHR documentation requirements
  • Meaningful Measures Initiative (est. savings of $128M)
    • 79 have been removed so far
    • MIPs will be revamped and will be done in close association with medical professional societies
  • Rural Healthcare strategies—supervision requirements have been reduced.
  • Modernize the current LCD structure, looking at information accessibility.
  • Prior authorization reform—appeals have been reduced.
  • Program integrity—Focus on interoperability with the Da Vinci Project (HL7 initiatives)
    • Develop guidelines to streamline access to coverage requirements
    • A prototype Medicare Fee for Service (FFS) Documentation Requirement Lookup Service. The prototype will be made accessible to pilot participants and will be populated with 1) a list of items/services for which prior authorization is required, and 2) the documentation requirements for Oxygen and Continuous Positive Airway Pressure (CPAP) devices.
    • Unleash critical data between payers and providers required for VBC workflows leveraging HL7 FHIR.
    • The Vision for the Da Vinci Project is illustrated below.

It was noted that 1 in every 5 U.S. dollars is spent on Healthcare, so these initiatives are imperative. This program is estimated to save $6.6 billion through 2021.

The AMA (Barbara Levy) and AAMC (American Association of Medical Colleges, 154 accredited med schools) both spoke and were supportive of the Patients over Paperwork initiative. The AAMC Supports the 2021 proposal for E&M decisions to be made based on time and medical decision making.  Both the AMA and AAMC acknowledged some wins in 2019 that allow the physicians to focus on relevant patient care such as the following:

  1. Requiring physicians to only focus on changes since last patient visit and the
  2. Physician is not mandated to redocument the chief compliant which was previously captured.

Patients Over Paperwork initiative is and will be successful because CMS has recognized that they must:

  • Collaborate across the agency
  • Be attentive to feedback from the medical community
  • Get CMS staff out of the office and into practices for observation and engagement.

Thank you to CMS Administrator Seema Verma and all others collaborating in this initiative to better ensure quality and unimpeded patient care. 

Patients Over Paperwork site – Click Here

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