- In a letter addressed to doctors, CMS Administrator Seema Verma reaffirmed the federal agency’s commitment to “turning the tide” of rising rates of physician burnout and reducing clinical documentation requirements to cut provider burden.
“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 in the letter.
Verma acknowledged the heavily-regulated, digitized healthcare industry has turned many clinicians passionate about improving the health of their patients into over-worked data entry clerks.
“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,” she said. “In a recent Medscape survey of over 15,000 physicians, 42 percent reported burnout.”
In response to the persistently rising rate of physician burnout nationwide, Verma promised CMS will work to preserve the patient-provider relationship by limiting providers’ time in front of computer monitors.
Verma also acknowledged the failure of several federal regulations intended to improve care quality, clinical efficiency, and clinical documentation.
“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,” she said.
Most detrimental to the success of EHR technology is the lack of interoperability between systems, which limits providers’ ability to engage in health data exchange for better-informed clinical decision-making. Without the ability to share complete patient health data, clinicians may run up against problems with unnecessary or duplicative testing, which increases hospital costs and hinders clinical efficiency.
As part of the effort to reduce provider burden and enable regulatory relief, CMS launched its Patients Over Paperwork initiative last year. The initiative has given rise to a proposed overhaul of evaluation and management (E&M) EHR clinical documentation requirements.
“E&M visits make up 40 percent of all charges for Medicare physician payment, so changes to the documentation requirements for these codes would have wide-reaching impact,” maintained Verma. “The current system of codes includes 5 levels for office visits – level 1 is primarily used by nonphysician practitioners, while physicians and other practitioners use levels 2-5.”
“The differences between levels 2-5 can be difficult to discern, as each level has unique documentation requirements that are time-consuming and confusing,” she continued.
In its 2019 Physician Fee Schedule and Quality Payment Program (QPP) proposed rules, CMS recommended shifting for a system with separate documentation requirements for each of the 4 levels physicians use to a system with only one set of requirements. The system would also only have one payment level each for new and established patients.
“Most specialties would see changes in their overall Medicare payments in the range of 1-2 percent up or down from this policy, but we believe that any small negative payment adjustments would be outweighed by the significant 3 reduction in documentation burden,” explained Verma.
In addition to reducing provider burden, CMS is also working to improve interoperability and EHR patient access through the MyHealthEData initiative.
“Patients must have control of their medical information; and physicians need visibility into a patient’s complete medical record,” wrote Verma. “Having all of a patient’s information available to inform clinical decision-making saves time, improves quality, and reduces unnecessary and duplicative tests and procedures.”
To further the aims of MyHealthEData, CMS proposed a redesign of incentives in the Merit-Based Incentive Payment System (MIPs) that includes changes to the MIPS promoting interoperability performance category. The incentives are now geared toward rewarding clinicians for engaging in health data exchange.
“We welcome your thoughts on our proposals, and we look forward to partnering with you to make them successful,” Verma concluded. “Patients and their families put their trust in your hands, and you should be able to focus on keeping them healthy.”