WASHINGTON — The Trump administration wants to give doctors more time with patients by rolling back the regulatory requirements foisted on physicians over the years.
“I’d like to think of regulatory reform in terms of painting a house,” said Seema Verma, administrator for the Centers for Medicare and Medicaid Services.
“Typically, repainting needs to occur every few years, and before you do it, you need to strip the layers of paint underneath,” she continued during a meeting with hospital, physician and other healthcare stakeholders held at the agency’s Washington office. “Unfortunately, during past administrations CMS has been simply applying new layers of paint without taking this essential step.”
Verma announced the launch of a “Patients over Paperwork” initiative, geared towards scrapping or reducing regulations while lowering healthcare costs and enhancing patient care.
“Regulations do have their role. They’re very important to assuring patient safety and quality and for program integrity, but there’s a fine line between being helpful and being a hindrance,” she said.
Over the last 5 years, the agency has released about 58 rules per year — the equivalent of 11,000 published manuscript pages, Verma continued.
She also highlighted providers’ frustration with reporting metrics into the electronic health records (EHR), asserting that currently, “the burden associated with reporting quality measures outweighs their utility.”
Verma told stakeholders they should expect to hear more news from the agency regarding efforts around “meaningful measurement.”
Rick Pollack, president and CEO of the American Hospital Association, applauded the agency for the steps it had already taken to reduce the administrative burden on providers, such as making Stage Three of Meaningful Use requirements optional and shifting certain bundled payment programs to a voluntary basis.
Asked for specific recommendations to further reduce the burden on providers, Pollack suggested the following changes:
- Modernize fraud and abuse rules to enable hospitals and physicians to design innovative care models
- Align and prioritize quality measures with a “focus on measures that matter”
- Work with the Office of the Inspector General to ensure fair audits (e.g., he cited concerns over sampling methods and ways of extrapolating data)
- Expand Medicare coverage for telehealth services
- Reconsider conditions of participation for Medicare (i.e., minimum health and safety standards)
Pollack also highlighted an AHA analysis, released Wednesday, which included more detailed recommendations related to the regulatory burden on physicians and hospitals.
Michael Munger, MD, president of the American Academy of Family Physicians, in Overland Park, Kansas, also shared his own recommendations for reducing physicians’ regulatory burden, which are “a major driver of physician burnout.”
On a typical day, primary care doctors spent about 27% of their time on “meaningful patient care” and about 49% on administrative activities, he said, according to a 2016 study published in Annals of Internal Medicine.
Specifically, Munger highlighted the challenge of prior authorizations. He said the average physician completes about 37 of these each week, according to a recent survey from the American Medical Association.
Munger recommended that CMS either eliminate or significantly scale back the need for prior authorizations on durable medical equipment (DME), diabetic supplies and generic drugs, particularly for products that treat chronic conditions.
Because of physicians’ considerable frustration with electronic health records, Munger also urged CMS to repeal the entire Advancing Care Information framework — the portion of the new Quality Payment Program that replaces “Meaningful Use” — and instead require physicians to use a certified electronic health record.