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CMS Administrator Seema Verma said recently at the Health Care Payment Learning and Action Network (LAN) Fall Summit that the agency is working to reduce the regulatory burden on hospitals by reducing the quality measurement requirements.
Verma announced what she called a “new comprehensive initiative on quality measures to reduce the burden of reporting called ‘Meaningful Measures.’”
“Since assuming my role at CMS, we are moving the agency to focus on patients first. To do this, one of our top priorities is to ease regulatory burden that is destroying the doctor-patient relationship. We want doctors to be able to deliver the best quality care to their patients,” Verma said.
“Regulations have their place and are important to ensuring quality, integrity, and safety in our healthcare system. But, if rules are misguided, outdated, or are too complex, they can have a suffocating effect on healthcare delivery by shifting the focus of providers away from the patient and toward unnecessary paperwork, and ultimately increase the cost of care.”
She noted that CMS recently announced its new initiative, “Patients Over Paperwork,” to address regulatory burden by assessing existing requirements and eliminating, or changing, those that do not benefit patients.
“As many of you are painfully aware, CMS is one of the leading agencies for promulgating regulations within the federal government. We publish nearly 11,000 pages of regulation every year. That’s a lot of paper … and it’s taking doctors away from what matters most — patients,” she said.
“The American Hospital Association, last week, published a report showing that health systems, hospitals, and post-acute care providers must comply with 629 mandatory regulatory requirements … and these entities spend nearly $39 billion a year solely on the administrative activities.”
The report also showed that an average-size hospital dedicates 59 full-time employees to regulatory compliance, she noted. “That’s a lot of provider time, money, and resources focused on paperwork instead of patients.”
Verma also discussed the Medicare Access and CHIP Reauthorization Act (MACRA), a complex new Medicare payment system for doctors that ended the Sustainable Growth Rate formula, which threatened severe Medicare payment cuts every year.
“But, in its place, our implementation of MACRA included extensive reporting requirements — more boxes for physicians to check. At this time, the only way to avoid MACRA’s extensive reporting requirements is for physicians to take on risk to be part of Advanced Alternative Payment Models, or APMs, which many practices are simply not ready for. Moreover, we have few Advanced APM models available — and hardly any for specialists,” she said.
“We are hearing that doctors are overwhelmed by MACRA’s new requirements and confused about the steps that they need to take.”
As part of efforts to minimize burden in implementation of MACRA, CMS is reexamining the process for conducting quality measurement “across the board,” Verma said.
“We want to move to a system that pays for value and quality — but how we define value and quality today is a problem. We all know it: Clinicians and hospitals have to report an array of measures to different payers,” she said. “The measures are often different and there are many steps involved in submitting them, taking time away from patients. Moreover, it’s not clear whether all of these measures are actually improving patient outcomes.”
She noted that inpatient hospitals report up to 61 quality measures, and 12 of them are “chart abstracted,” meaning that hospital staff must manually enter the values.
“Some family practitioners have to report nearly 30 measures to seven different payers, again which leads to less time focused on patients and is contributing to clinician burnout,” Verma said. “We have too many measures. We are measuring process and not outcomes.”
The new Meaningful Measures takes a new approach to quality measures to reduce the burden of reporting on all providers, she said.
“Meaningful Measures will involve only assessing those core issues that are the most vital to providing high-quality care and improving patient outcomes,” she said. “It’s better to focus on achieving results, as opposed to having CMS try to micromanage and measure processes. The ultimate goal of Meaningful Measures is to direct efforts on high-priority areas.”