- In a recent letter to CMS, HIMSS and the Association of Medical Directors of Information Systems (AMDIS) offered suggestions to reduce administrative burden on providers as part of the CMS Patients Over Paperwork Initiative.
The Patients Over Paperwork Initiative is a collaborative effort between AHA, the American Academy of Family Physicians, and 33 other provider organizations intended to evaluate and streamline regulations to minimize regulatory burden and increase clinical efficiency.
The prevailing problem of high administrative burden stems from needless federal regulations that do little to improve care quality or patient safety, HIMSS and AMDIS maintained. The organizations stated an interest in working with HHS to eliminate unnecessary reporting requirements and improve clinical and operational efficiency in healthcare.
“Ultimately, HIMSS and AMDIS want clinicians to be able to focus their time on actions that make sense, such as caring for patients and delivering better outcomes,” HIMSS and AMDIS said in the joint letter. “We want to help CMS and ONC reduce burden so that our members and other practitioners can deliver better care.”
Toward this end, the organizations recommended CMS promote health IT innovation.
Specifically, HIMSS and AMDIS stated CMS should work to ensure EHR systems facilitate streamlined, shared clinical decision-making and improvements in clinical efficiency.
“In addition, there will be greater demands placed on technology to help make the right information more accessible at the right time so it is more meaningful and impactful to patients and providers,” wrote the organizations.
HIMSS and AMDIS added CMS should encourage health IT developers to innovate technologies that will leverage health data for more efficient and safe care delivery.
“Overall, HIMSS and AMDIS want to contribute to efforts to develop more advanced tools so clinicians can be more effective and manage patient care better with fewer resources,” stated the organizations.
“Innovations focused on advanced visualization and clinical decision support solutions will become a larger part of the health information and technology infrastructure moving forward and should be capitalized on to help address burden issues,” the duo continued.
HIMSS and AMDIS also urged that CMS reduce administrative burden by fostering a learning health system supported by more efficient processes.
“We envision a system that utilizes health information and technology to drive to that future state where patients receive higher quality, safer, and more efficient care and clinicians can focus on better outcomes,” wrote the organizations.
“As CMS continues to change its focus, the need to institute broader quality outcomes or process reporting requirements wanes, thereby contributing to the overall easing of burden on clinicians,” HIMSS and AMDIS added.
Team-based care that allows for quality reporting by the entire clinical staff may also help to reduce administrative burden, the organizations suggested.
“CMS has an opportunity to reinforce the importance of team-based care in all settings by emphasizing and equalizing reporting across the entire licensed clinical staff,” the duo wrote.
Instead of requiring individual physicians to report data, HIMSS and AMDIS suggested CMS broaden its acceptance of EHR clinical documentation from all members of a patient’s care team.
“All this documentation does not have to be contained exclusively in the physician-specific note,” the organizations maintained.
“The quality of the clinical notes from nurses, pharmacists, and the rest of the care team will contribute to documentation that represents interprofessional practice in support of optimal patient care,” HIMSS and AMDIS continued.
The organizations also acknowledged the positive changes contained within the CMS 2019 Inpatient Prospective Payment System (IPPS) proposed rule.
However, HIMSS and AMDIS suggested CMS could further reduce administrative burden by aligning hospital quality measure reporting requirements, specifications, and timelines with requirements from accreditation organizations, private payers, and state governments.
“Until such an alignment occurs, many hospitals will be required to report an equivalent similarly-focused quality measure using different specifications, data definitions, and timelines in different programs,” the organizations emphasized.
HIMSS and AMDIS also advised CMS to design new electronic clinical quality measures (eCQMs) to collect and repot data as part of clinical workflows.
“Significant progress has been made to extract meaningful clinical data from EHRs while minimally affecting current workflow and CMS should build on these efforts moving forward when designing programmatic requirements,” stated HIMSS and AMDIS.
The organizations suggested CMS integrate these proposed changes into the new PI program performance category of the Merit-based Incentive Payment System (MIPS) part of the Quality Payment Program (QPP).
Finally, HIMSS and AMDIS recommended CMS reuse data from other sources to minimize reporting requirements and simplify evaluation and management (E/M) coding and documentation requirements.
“E/M documentation requirements and coding concerns are a significant source of burden, and we ask CMS to review and revise E/M policies and call on our organizations as well as other stakeholder groups to collaborate on developing workable solutions,” wrote the organizations.
These recommendations may help to cut administrative burden on providers and curb rising rates of provider burnout.