To Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs
Public feedback will shape initiative’s next steps and future progress in tackling unnecessary burden on healthcare providers
The Centers for Medicare & Medicaid Services (CMS) (@CMSGov) issued a Request for Information (RFI) seeking new ideas from the public on how to continue the progress of the Patients over Paperwork initiative. Since launching in fall 2017, Patients over Paperwork has streamlined regulations to significantly cut the “red tape” that weighs down our healthcare system and takes clinicians away from their primary mission—caring for patients. As of January 2019, CMS estimates that through regulatory reform alone, the healthcare system will save an estimated 40 million hours and $5.7 billion through 2021. These estimated savings come from both final and proposed rules.
The RFI on Reducing Administrative Burden to Put Patients over Paperwork invites patients and their families, the medical community, and other healthcare stakeholders to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our healthcare system’s resources from needless paperwork to high-quality care that improves patient health.
“Patients over Paperwork remains a top priority and a driving force in lowering healthcare costs,” said CMS Administrator Seema Verma. “In step with the Trump Administration’s Cut the Red Tape initiative to reduce overly burdensome regulations across the federal government, Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health. We are doubling down on efforts to decrease healthcare costs by reducing administrative burden. In removing what doesn’t add value, we’re making room for what does. Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks. Since launching Patients over Paperwork in late 2017, CMS has worked closely with the healthcare community to relieve regulatory burden and maintain flexibility and efficiency in Medicare and Medicaid, and we’re excited about the innovative ideas that today’s RFI will bring as we build on our progress and continue to achieve cost and time savings.”
Today’s RFI provides an opportunity to share new ideas not conveyed during the first Patients over Paperwork RFI in 2017 and continue the national conversation on improving healthcare delivery. CMS is especially seeking innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve:
- Reporting and documentation requirements
- Coding and documentation requirements for Medicare or Medicaid payment
- Prior authorization procedures
- Policies and requirements for rural providers, clinicians, and beneficiaries
- Policies and requirements for dually enrolled (i.e., Medicare and Medicaid) beneficiaries
- Beneficiary enrollment and eligibility determination
- CMS processes for issuing regulations and policies
Patients over Paperwork: Key Burden Reduction Milestones to Date
Leading up to the RFI on Reducing Administrative Burden to Put Patients over Paperwork, CMS gathered feedback on burdensome requirements from medical and patient communities through other RFIs, listening sessions, and on-site meetings with frontline clinicians, healthcare staff, and patients. These efforts used “human-centered design,” a participatory approach that helps CMS understand the every-day impact of burdensome rules and build better policies that meet people’s needs.
CMS is working every day to reduce regulatory burden while safeguarding patient safety, quality, and program integrity. To date, CMS has addressed or is in the process of addressing 83 percent of the actionable areas of burden identified through the 2017 RFI. We also received input from over 2,000 stakeholders across 23 states through interviews, listening sessions and on-site visits to healthcare facilities, practices, and beneficiaries’ homes. CMS is pleased to share key achievements in burden reduction so far through Patients over Paperwork.
Simplified Documentation and Coding
CMS continues to work with healthcare providers and clinicians to modernize documentation requirements and billing codes—which in turn will free up more time for patients, lessen clinician burnout, and bolster the doctor-patient relationship. Practical examples of changes CMS has already made include allowing initial prescriptions of immunosuppressive drugs to be shipped to an alternate address other than the beneficiary’s home to ensure timely access to these drugs when the beneficiary does not return home immediately after discharge. As part of Patients over Paperwork, this policy change was a request by the industry to help ensure patient access during the transition of care. In another example, CMS confirmed regulatory changes to home health recertification and eliminated the need for a physician to include a separate statement about how much longer home health services are needed. These common-sense measures add up to save time and cut down on paperwork throughout a clinician’s day.
Improved Quality and Operational Efficiency
With less administrative burden, healthcare staff can turn more of their energy toward ensuring patient safety and high-quality care. That is one aim of the Patient Driven Payment Model, a new case-mix classification system that applies to Medicare payments to skilled nursing facilities (SNFs) beginning in October 2019. This innovative system will tie SNF payments to patients’ conditions and care needs rather than the quantity of services provided, and will simplify the current complicated paperwork requirements for patient assessments. Moreover, the simplified patient assessments will significantly reduce reporting burden, saving an estimated $2 billion over 10 years.
America deserves nursing homes that ensure residents are treated with dignity and kept safe from abuse and neglect; that are rewarded for value and quality; and that make patient outcomes transparent to consumers—all without unnecessary paperwork that keeps providers from focusing on patients. CMS has demonstrated our commitment to this path by developing a five-part plan to ensure America’s nursing home care is of the highest possible quality. Ensuring access to quality nursing home care is a top priority, and it’s a delicate balance. As we have seen time and again, more regulation is not necessarily better regulation, nor does it always translate into better care or outcomes. Every time we implement a new rule or requirement, we think about minimizing burden while keeping patients safe.
By reducing burden through Patients over Paperwork, CMS is allowing clinicians to spend more time with their patients, which is particularly important in a nursing home setting where residents have more complex care needs, and care decisions are sometimes directed by family members. Reducing provider burden can also lower administrative costs, allowing facilities to dedicate their resources to other areas, such as improving patient care. Meanwhile, unnecessary red tape can create staffing challenges and increase operating costs without improving quality or safety, which particularly threatens facilities in rural and underserved areas and the residents who depend on them.
The CMS patient-centered Meaningful Measures initiative, also launched in 2017, aligns with Patients over Paperwork to minimize burden in the healthcare system. Through Meaningful Measures, CMS works closely with healthcare stakeholders to identify and pursue high-priority areas for quality measurement and improvement to achieve better outcomes for patients, their families, and healthcare providers while reducing clinician burden. Through policies advancing Meaningful Measures, CMS has eliminated 79 overly burdensome, redundant, or low-value measures for a projected savings of $128 million and anticipated reduction of 3.3 million burden hours through 2020. Additionally, the agency has reduced the burden of reporting measures by enabling their electronic submission and incentivizing use of clinical registries. Along with improving patient outcomes, the goal of Meaningful Measures is ensuring transparent quality and cost information that provides a picture of value, which empowers consumers to make informed choices about their healthcare.
Changing CMS Culture
Every Center at CMS has helped reduce burden through the federal rulemaking process, sub-regulatory guidance, and policy updates. A dedicated team was established and continues to coordinate this work to ensure CMS is minimizing burden across the agency to more effectively serve our public stakeholders. The team leads CMS’s human-centered design and customer-engagement efforts to make sure customers are at the center of the agency. CMS staff are encouraged to leave their offices to observe the healthcare system firsthand. Visiting healthcare facilities aids in their understanding of customer needs and affects policies in ways that can’t be accomplished by sitting at a desk. Staff have told us these firsthand experiences meeting with Medicare beneficiaries and talking with clinicians have been invaluable, helping to “humanize” the work we do at CMS and see its direct impact. This deeper understanding of our customers has transformed how we approach everything, from designing training materials about Medicare coverage to improving the enrollment process.
More Information on the RFI on Reducing Administrative Burden to Put Patients over Paperwork
The RFI on Reducing Administrative Burden to Put Patients over Paperwork is posted in the Federal Register.
Comments must be submitted by August 12, 2019.
See more information on the Patients over Paperwork initiative.