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 healthcare 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 healthcare 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 healthcare system. Once again, thank you for your
service to your patients.
Sincerely,
Seema Verma
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