A Letter to
Doctors from CMS Administrator Seema Verma
Dear Doctor,
Thank you for the difference you make in your patients’
lives. Many of our nation’s best and brightest students go into
medicine – the competition is intense for every spot. To become a
practicing physician, you had to put in years of training, hours of
studying, and long days and nights on the wards.
Your dedication and commitment have enabled you to join
the profession that makes up the core of our health care system. But
after years of education, training, and hard work, our system is not
fully leveraging your expertise. Instead, doctors today spend far too
much of their time on burdensome and often mindless administrative
tasks.
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. Our system has
taken our most brilliant students and put them to work clicking through
screens and copying and pasting. 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.
In a recent Medscape survey of over 15,000 physicians, 42
percent reported burnout. Enough is enough. CMS’s focus is on putting
patients first, and that means protecting the doctor-patient
relationship. We believe that you should be able to focus on delivering
care to patients, not sitting in front of at a computer screen.
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.
Electronic Health Records were supposed to make it easier for you to
record notes, and the government spent $30 billion to encourage their
uptake. But the inability to exchange records between systems – and the
increasing requirements for information that must be documented – has
turned this tool into a serious distraction from patient care.
CMS is committed to turning the tide. President Trump has
made it clear that he wants all agencies to cut the red tape, and CMS
is no exception. Last year, we launched our “Patients Over Paperwork”
initiative, under which we have been working to reduce the burden of
unnecessary rules and requirements. As part of this effort, we have
proposed an overhaul of the Evaluation & Management (E&M)
documentation and coding system to dramatically reduce the amount of
time you have to spend inputting unnecessary information into your
patients’ records. 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.
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.
We’ve proposed to move from a system with separate
documentation requirements for each of the 4 levels that physicians use
to a system with just one set of requirements, and 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 reduction in
documentation burden. If you add up the amount of time saved for
clinicians across America in one year from our proposal, it would come
to more than 500 years of additional time available for patient care.
In addition to streamlining documentation, under the
leadership of the White House’s Office of American Innovation, we are
advancing the MyHealthEData Initiative which promotes the
interoperability of electronic medical records. Patients must have
control of their medical information; and physicians need visibility
into a patient’s complete medical record. 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. CMS is taking action to make this vision a reality,
including recently proposing a redesign of the incentives in the
Merit-Based Incentive Payment System or “MIPS” to focus on rewarding
the sharing of health care data securely with patients and their
providers.
We welcome your thoughts on our proposals, and we look
forward to partnering with you to make them successful. Patients and
their families put their trust in your hands, and you should be able to
focus on keeping them healthy. And to secure the future strength of our
system, we must make sure that the nation’s best students continue to
choose to go into medicine.
We need your input to improve the health care system. Once
again, thank you for your service to your patients.
Sincerely,
Seema Verma
The Medicare Learning Network®, MLN Connects®, and
MLN Matters® are registered
trademarks of the U.S. Department of Health and Human Services
(HHS).
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