Cut the Clutter, Academy Tells HHS

In response to a new push by the federal government to trim its own regulatory burden, the Academy has asked HHS to take a hard look at a myriad of rules and regulations that too often are rife with unintended consequences and unfunded mandates that negatively affect family physicians.

"Because family physicians and other primary care physicians provide a broad range of health care services to Medicare, Medicaid, Children's Health Insurance Program and private insurance patients, many of these well-intended goals particularly disadvantage primary care practices," said AAFP Board Chair Lori Heim, M.D., of Vass, N.C., in a June 29 letter (4-page PDF; About PDFs) to HHS Secretary Kathleen Sebelius.

Heim singled out costs family physicians bear when they provide translator services to Medicare and Medicaid patients, as well as precious time FPs waste on activities such as securing prior authorization for a patient's medication.

She also chided HHS for subjecting all physicians to multiple and often overlapping documentation and certification requirements in the agency's effort to "'detect, prevent and apprehend the criminals that attempt to fraudulently bill the Medicare and Medicaid Programs."

Heim's letter was in direct response to HHS' "Preliminary Plan for Retrospective Review of Existing Rules" (18-page PDF; About PDFs), which the agency released May 18. The HHS plan, in turn, was spawned by Executive Order 13563 (3-page PDF; About PDFs), which President Obama signed on Jan. 18. In that order, the president called for each federal agency, including HHS, to perform an agency-wide review of its regulations, with the goal of tailoring them "to impose the least burden on society."

In the letter to Sebelius, Heim also suggested that HHS

Heim told Sebelius that Medicare's time-consuming enrollment process greatly frustrates physicians. "All too often, physicians wait several months for CMS contractors to process an enrollment application, and these delays cause severe financial hardships for (physician) practices," she said. "The AAFP continues to urge CMS to promptly and drastically improve the Medicare physician enrollment process."

Heim also took aim at Medicare's signature requirements, calling them "overwhelming compliance burdens and unnecessarily time-consuming." She specifically asked for more conformity in instructions given to different Medicare audit contractor groups about the language they use in their "additional documentation request" letters to physicians whose claims have been singled out for review.

A separate letter (2-page PDF; About PDFs) mirroring the Academy's request for a reduction in burdensome signature compliance requirements went to CMS Administrator Donald Berwick, M.D., on June 23.

"The AAFP urges CMS to consider these comments and develop a comprehensive, yet understandable physician signature policy that family physicians will find acceptable and that (will) be provided in all requests for additional documentation," said Heim.

The AAFP based its comments in part on information gleaned from a recent survey conducted by the AMA in which 2,000 physicians -- including many family physicians -- were encouraged to identify the Medicare regulations that drive up medical practice costs and reduce physician time with patients.