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Keep Tabs on CMS Initiative to Reduce Paperwork

January 25, 2018 10:36 am News Staff – It's safe to say that family physicians give a universal thumbs down to the paperwork nightmare that the AAFP is fighting hard to tame. That said, when CMS announced a new initiative last fall dubbed Patients Over Paperwork, even skeptics were bound to be interested in its progress.

As the name suggests, the agency aims to use this program to reduce burdensome regulations and streamline federal requirements; that, in turn, should shrink the piles of paperwork that keep physicians from their patients.

At the initiative's rollout, CMS Administrator Seema Verma, M.P.H., admitted that the agency publishes nearly 11,000 pages of regulations each year.

Now, there's an easy way for physicians to keep an eye on improvements that are taking place. In December 2017, CMS launched a newsletter to ensure physician connectivity, and this month, the agency took advantage of the January issue to urge physicians to get the newsletter in their email inbox free of change.

quality measures,
the Quality Payment Program (QPP),
appropriate use criteria for advanced diagnostic imaging,
documentation review, and
quality and safety oversight.

Topics are addressed in an easy-to-follow "You said" and "We heard you" format that cuts right to the issues that need attention.

For instance, CMS reported that physicians and the organizations that represent them told the agency in no uncertain terms that quality programs had too many measures that were not meaningful to patients or providers, and that reporting on these measures stole valuable time away from patient care.

To fix the problem, CMS said it took steps in 2017 to reduce the number of quality measures in its programs and would continue that effort in 2018.

In another example, physicians told CMS that quality and payment programs were confusing and data submission was overly complicated.

In response, CMS noted that it consolidated the QPP data submission experience and that beginning in 2018, physicians were able to log on to one site -- QPP.CMS.gov -- to submit data to satisfy all Merit-based Incentive Payment systems' reporting requirements.

Want to read the newsletter without signing up for the email? CMS maintains an archive of the Patients Over Paperwork newsletter beginning with the December 2017 issue.

STORY HIGHLIGHTS

In a detailed letter to HHS, the AAFP outlined policy changes that could promote greater competition in the health care marketplace and enhance patient choice.
Independent physician practices need an environment that allows them to thrive, but the continuing consolidation of insurers and large health systems threatens their viability.
Federal officials should promote payment methods that boost competition in the marketplace and create greater choice for patients, said the Academy.

Federal officials should promote payment methods that boost competition in the marketplace and create greater choice for patients. Mergers among hospitals in a single market increase costs for patients and drive up prices for low-value medical services.

"We strongly believe that this is an area where greater competition would benefit patients, physicians, and other health care providers," the letter stated. "Allowing hospitals and health systems to expand their stranglehold on the marketplace is harmful for patients, physicians, employers, and federal and state health care programs."

When a small number of commercial carriers dominate specific geographic markets, they exert inordinate power over consumer choice and payment. For example, Medicare Advantage plans now cover 19 million beneficiaries, yet just two insurers account for 41 percent of this market. On a similar note, Blue Cross Blue Shield accounts for 85 percent of the individual market and 93 percent of the large group market in Alabama.

When large health systems merge, they often shrink their networks, meaning patients may be forced to go out of network to maintain a relationship with their physician. For physicians, greater consolidation means they are often pressured to accept lower payment levels to stay within a particular network.

"The AAFP is deeply troubled by the explosion of mergers between hospitals and health systems," said the letter. "These mergers, in our opinion, are driving up costs, decreasing competition, and creating an escalating arms race in medical technology and costly, low-value medical services. No evidence exists that these mergers are decreasing prices in those marketplaces where they occur."

Another trend that limits access is the rapid rise in high-deductible health plans that dominate the employer-sponsored insurance market. Individuals with these plans often have annual deductibles of $2,000 or more and, as a result, may delay or forgo care rather than pay for a primary care visit out-of-pocket.

"Higher deductibles create a financial disconnect between individuals, their primary care physician, and the broader health care system," the letter noted.

The AAFP has proposed a primary care benefit that would be standard for all commercial policies under which visits to a primary care physician or medical team would not be subject to a deductible or copayment.

Finally, the letter presses the agency to remove legal barriers for patients who want to use their health savings accounts to pay for direct primary care (DPC) arrangements. Current tax law prevents patients from doing so because the IRS considers DPC to be insurance. The AAFP has supported legislation previously introduced in Congress that would change that designation.