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The Medicare agency wants to weed out reporting measures for doctors and other health-care providers that don’t focus on patients’ health outcomes, its top official said Oct. 30.
“You’ve got providers spending a lot of time documenting very routine things,” Seema Verma, who heads the Centers for Medicare & Medicaid Services, told Bloomberg Law in an interview.
The CMS’s latest deregulatory initiative, named Meaningful Measures, seeks to cut down on requiring doctors report on process measures, such as documenting the number of hypertensive patients who have had their blood pressure taken in the last three months. The goal is to instead emphasize outcomes measures that determine whether the process is having the desired effect on the patient, such as documenting patients whose most recent blood pressure was under a certain level.
The initiative follows another one launched last week called Patients Over Paperwork, with the aim of removing regulations that interfere with doctors spending time with patients.
The efforts are in response to complaints by doctors, hospitals, and others in the health-care industry that they’re overwhelmed by government requirements.
“As many of you are painfully aware, CMS is one of the leading agencies for promulgating regulations within the federal government,” Verma told a conference sponsored by the Health Care Payment Learning and Action Network (LAN) Fall Summit.
The doctor payment system, called the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), requires doctors who treat a large number of Medicare beneficiaries to either align themselves with an advanced alternative payment model or be subject to a quality performance score that could lead to payment reductions. Their scores are a result of their performance on quality measures. But many of the quality measures are aimed at the process, not the outcome, Verma said.
Final MACRA rules for 2018, the second year of the program, are expected to be published the week of Oct. 30, she said.
“We’re going to actually be going through all the programs,” not just MACRA, checking the number of measures for each, determining if they’re process or outcomes, and the level of burden, she told Bloomberg Law.
Hospital star ratings are another example of a program the agency is evaluating for simplification, she told the conference.
“Inpatient hospitals report up to 61 quality measures with 12 of these measures being chart abstracted, meaning that hospital staff must manually enter the values,” Verma said.
Verma said she also wants to ease the regulatory burden for Medicare Advantage plans with the goal of expanding the program.
“We’d like to have even more plans in the system,” she told the conference.
In the area of alternative models, she told Bloomberg Law that the agency’s Center for Medicare and Medicaid Innovation will be announcing new models on payment for high-cost drugs and on primary care. There will also be announcements on voluntary bundled payment models, she said.
Outside the agency, the CMS is undertaking listening sessions, so far with doctors, hospitals, and skilled nursing facilities, to hear about specific challenges they’re facing, she told Bloomberg Law.
Inside the agency, “we’re doing journey mapping to see how regulations come together in the day in the life of the provider or the beneficiary,” she said.
Doctor groups seemed cautiously positive about the agency’s new quality measures initiative.
The Medical Group Management Association supports the CMS’s efforts to ensure Medicare quality measurement is meaningful for physician practices, Anders Gilberg, MGMA’s senior vice president of government affairs, said in a statement.
The American College of Physicians wants the CMS to collaborate on developing meaningful measures with specialty societies, frontline clinicians, and electronic health record vendors to decrease clinician burden, Shari Erickson, the group’s vice president of governmental affairs and medical practice, told Bloomberg Law.
The American Association of Neurological Surgeons/Congress of Neurological Surgeons, cautioned against fitting a meaningful measures program to all physician types. “While intuitively it makes sense to focus a program on core measures that improve patient outcomes,” it’s important to ensure it doesn’t result in a one-size-fits-all program, Katie O. Orrico, director of the group’s Washington office, told Bloomberg Law.Michael Munger, president of the American Academy of Family Physicians, told Bloomberg Law that, although members haven’t seen details of the initiative, the group is encouraged that the CMS promised to focus on patient outcomes rather than on process.
Primary-care physicians spend only 27 percent of their time caring for patients, but nearly half their time on administrative activities, Munger added.
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