Patients over Paperwork: A Journey Forward

Patients over Paperwork: A Journey Forward


>>GOOD MORNING, EVERYBODY.
I’M DR. MARY GREEN. I LEAD THE PATIENTS OVER PAPERWORK INITITIATIVE ALONG WITH DR. KATE
GOODRICH UNDER THE SUPERVISION OF ADMINISTRATOR VERMA.
THANK YOU FOR JOINING US TODAY AS WE CELEBRATE THE WORK DONE TO DATE ON PATIENTS
OVER PAPERWORK AND WE LOOK FORWARD TO MORE
THINGS WE CAN DO. BEFORE I INTRODUCE THE
ADMINISTRATOR, I WANT YOU TO TAKE A LOOK AT YOUR AGENDA
QUICKLY AND JUST KNOW THERE’S A HASHTAG AT THE BOTTOM, IF YOU
ARE A LIVE TWEETER, YOU ARE WELCOME TO DO THAT.
THE HASH TAG IS AT THE BOTTOM OF THE AGENDA.
I WOULD LIKE TO INTRODUCE CMS’S ADMINISTRATOR, SEEMA VERMA.
[ APPLAUSE ]>>ALL RIGHT.
HELLO. AND THANK YOU FOR JOINING US
TODAY. AS WE MARK THE 2-YEAR
ANNIVERSARY OF ONE OF OUR SIGNATURE INITIATIVES PATIENTS
OVER PAPERWORK. I WANT TO PAUSE TO THANK
CONGRESSMAN BOUCHARD AND BOURGES FOR THEIR ATTENDANCE
TODAY. THEY ARE KEY PLAYERS IN THE
EFFORT TO DELIVER A HEALTHCARE SYSTEM THAT WORKS FOR PATIENTS
AND THEIR CONTRIBUTIONS AND SUPPORT FOR CMS ON THIS
INITIATIVE HAVE BEEN INVALUABLE AND WE ARE EXTREMELY GRATEFUL
AND THANKFUL. THEY WILL BE DELIVERING A FEW
WORDS IN A MOMENT AND LOOK FORWARD TO HEARING FROM THEM.
LAUNCHED IN 2017 PATIENTS OVER PAPERWORK IS THE CENTRAL PLANK
OF CMS’S ONGOING CONTRIBUTION TO PRESIDENT TRUMP’S ORDER TO
CUT THE RED TAPE. SINCE THAT TIME WITH RECENT
EXECUTIVE ORDER ON MEDICARE WE HAVE SEARCHED HIGH AND LOW FOR
DUPLICATIVE AND UNNECESSARY PAPERWORK.
IT REAMS PRESCRIPTIVE GOVERNMENT REGULATION THAT’S
DICTATE PROCESSES WHERE THE HEALTH SYSTEM HAS FAILED.
REGULATIONS SHOULD IDENTIFY EXPECTED OUT COMES RESULTS AND
STANDARDS. NOT MICROMANAGE EVERYTHING
THAT THE HEALTH INDUSTRY DOES. AND PATIENTS BELONG AT THE
CENTER OF THE HEALTHCARE SYSTEM AND FOR TOO LONG THEY HAVE BEEN
SHUNTED ASIDE AS MOUNTAINS OF PAPERWORK HAVE COME FIRST.
$266 BILLION A YEAR COULD BE
ATTRIBUTED TO ADMINISTRATIVE COSTS.
SO WE HAVE LAUNCHED THIS INITIATIVE TO RIGHT THE SHIP BY
GETTING RID OF OUTDATED REGULATIONS THAT DON’T MAKE
SENSE AND EACH PROVIDER BURDEN REDUCE ADMINISTRATOR COSTS AND
PUT PATIENTS FIRST. THE PROCESS BEGAN WITH A WIDE-
RANGING REQUEST FOR INFORMATION WE DID IN 2017 AND YIELDED OVER
3,000 DISCRETE DATA POINTS RELATED TO OVER 1100 DIFFERENT
ISSUES. AND TO DATE, I’M PROUD TO
REPORT WE HAVE ACTED ON, OR ARE WORKING ON OVER 80% OF THE
ITEMS MENTIONED WITH THE REMAINDER OF THOSE FALLING
OUTSIDE OF CMS’S PURVIEW. IN AUGUST OF THIS YEAR WE
RECEIVED OVER $560 SUBMISSIONS TO A NEW R.F.I. WE ARE
CURRENTLY ANALYZING. IN ADDITION, WE HAVE ACTUALLY
GONE OUT TO THE FRONT LINES TO UNDERSTAND THE IMPACT OF OUR
REGULATIONS. THE PATIENTS OVER PAPERWORK
INITIATIVE HAS PUSHED THE CMS TEAM TO TAKE A NEW APPROACH TO
RULE MAKING. GETTING OUR STAFF OUT OF THE
OFFICE AND SEEING HOW THEIR WORK TRULY AFFECTS PROVIDERS
CLINICIANS, STAFF AND BENEFICIARIES AND BY GENUINELY
LISTENING TO THE CONCERNS OF STAKEHOLDERS GOVERNMENT IS
FACILITATING INNOVATION RATHER THAN STYMYING IT.
IT’S ALLOWED US TO CONDUCT 800 INTERVIEWS, 185 WITH SUBJECT
MATTER EXPERTS AND 182 LISTENING SESSIONS ACROSS THE
NATION. WHILE THERE’S MUCH MORE TO BE
DONE WE HAVE MADE CONSIDERABLE INROADS AND BEFORE PREVIEWING
WHAT WILL COME IN THE FUTURE I WOULD LIKE TO GIVE YOU A BRIEF
TOUR OF SOME OF THE HIGHLIGHTS OF THE WORK DONE SO FAR.
WE RELEASED OMNIBUS REDUCTION PROPOSED MODERNIZATION OF
REGULATIONS IMPLEMENTING THE STARK LAW.
THE OMNIBUS RULE AFFECTED PROVIDERS ACROSS THE HEALTHCARE
SYSTEM, REMOVED MEDICARE REGULATIONS THAT STOOD LIKE A
BRICK WALL BETWEEN PATIENTS AND THEIR DOCTORS AND DID NOTHING
TO ADVANCE PATIENT HEALTH AND SAFETY.
BY ITSELF THAT RULE WILL SAVE $800 MILLION AND 4.4 MILLION
BURDEN HOURS. IN OUR LISTENING SESSIONS STARK
WAS CONSISTENTLY RANKED AMONG THE TOP CONCERN OF PROVIDERS
AND CLINICIANS AND SO OUR PROPOSED RULE RESPONSE TO THESE
CONCERNS, IT EASES THE REGULATORY BURDEN ON VALUE
BASED ARRANGEMENTS AND PROVIDES BADLY NEEDED NEW GUIDANCE TO
HELP COMPLIANCE BURDEN UNDER THE STARK LAW AND WE RELEASED A
PROPOSED RULE THAT APPLIES TO NURSING HOMES.
I CAN TELL YOU I REMEMBER VISITING A NURSING HOME A
COUPLE YEARS AGO AND THE STAFF BROUGHT ME MULTIPLE MASSIVE
BINDERS OF PRINTOUTS OF LITANY OF OUTDATED RULES THAT SEEMED
TO DICTATE EVERYONE OF THEIR DECISIONS.
THE NURSING HOME RULE IN PARTICULAR WOULD SAVE $616
MILLION, MONEY THAT COULD BE REINVESTED BACK INTO PATIENT
CARE. AND WHILE PHYSICIAN BURN OUT
REMAINS VERY HIGH, WE ARE TURNING OUR ATTENTION TO THAT
ISSUE. LAST YEAR WE MADE HISTORIC
PROPOSALS TO SIMPLIFY HOW DOCTORS DOCUMENT, EVALUATION
AND MANAGEMENT CODES USED TO BILL MEDICARE AND THOSE CODES
HAVE BEEN IN PLACE FOR OVER 20 YEARS AND WE ARE CONTINUING
THAT WORK THIS YEAR. ADDITIONALLY, TO MAKE IT EASIER
FOR TEACHING PHYSICIANS TO TRAIN THE NEXT GENERATION OF
DOCTORS WE INCREASE FLEXIBILITY FOR MEDICAL STUDENTS TO PUT
INFORMATION INTO THE ELECTRONIC HEALTH RECORDS AND WE HAVE
PROPOSALS TO EXTEND THIS POLICY TO OTHER CLINICAL TEACHERS LIKE
PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS.
I ALSO WANT TO HIGHLIGHT OUR MEANINGFUL MEASURES INITIATIVE.
IT FOCUSES PARTICULARLY ON QUALITY RATHER THAN PROCESS OF
GETTING RID OF MEASURES THAT WERE OUTDATED AND THAT MEANS
CUTTING ACCUMULATED PROCESS REQUIREMENTS THAT DON’T
PRIORITIZE PATIENTS AND THROUGH THAT EFFORT WE HAVE ELIMINATED
79 MEASURES ACROSS THE SYSTEM FOR PROJECTED SAVINGS OF $128
MILLION AND $3.3 MILLION BURDEN HOURS THROUGH 2020 AND WE ARE
NOT DONE. WE PROPOSED COMPLETELY REVAMPED
PROGRAM, A NEW PROCESS THAT WOULD ALLOW US TO CREATE
MEASURE IN PARTNERSHIP WITH MEDICAL PROFESSIONAL SOCIETIES.
WE HAVE ALSO PLACED AN UNPRECEDENTED PRIORITY ON
STRENGTHENING THE RURAL HEALTHCARE SYSTEM.
SO UNDER OUR RURAL HEALTH STRATEGY WE ARE APPLYING A LENS
TO THE VISION AND WORK OF CMS INVESTIGATING A WAY TO
ALLEVIATE FOR PROVIDERS. REDUCE ROLE OF SUPERVISION FOR
HOSPITAL SERVICES TO MAKE IT EASIER FOR RURAL HOSPITALS TO
PROVIDE ACCESS TO THESE SERVICES.
WE WILL HAVE A SESSION ON THAT TODAY SO WE LOOK FORWARD TO
HEARING MORE FROM YOU ABOUT HOW WE CAN GO EVEN FURTHER ON THAT
EFFORT. AND IT’S IMPORTANT TO NOTE WE
ARE TAKING CARE OF EFFORTS TO CUT BACK ON NEEDLESS REGULATORY
REQUIREMENTS AROUND PROGRAM INTEGRITY.
OUR EFFORTS HAVE REDUCED PROVIDER BURDEN AND APPEALS TO
AN ALL-TIME LOW. BUT THERE IS CERTAINLY MORE
WORK TO BE DONE SO WE ARE WORKING ON SOMETHING CALLED DA
VINCI PROCESS, PRIVATE SECTOR INITIATIVE FOCUSED ON DATABASE
STREAM TO STREAMLINE ACCESS TO RECOVERY PROCESS.
I CAN GO ON AND ON ABOUT THE CHANGES BUT ALL TOLD OUR
REDUCTION EFFORTS HAVE SAVED THE ENTIRE SYSTEM $6.6 BILLION
AND 42 MILLION BURDEN HOURS THROUGH 2021.
IT’S NO SECRET THAT HEALTHCARE COSTS HAVE BEEN RISING FOR
DECADES AND BY 2026 $1 IN EVERY $5 DOLLARS IN OUR ECONOMY WILL
BE SPENT ON HEALTHCARE. IN OTHER WORDS, THESE SAVINGS
COULD NOT COME AT A BETTER TIME.
I WANT TO SINCERELY THANK ALL THE STAKEHOLDERS PROVIDING
INVALUABLE INPUT, PARTICULARLY THE CLINICIANS ON THE FRONT
LINES DAY IN AND DAY OUT. BEFORE I CLOSE I WANT TO SAY
WHILE I FOCUSED ON REGULATORY CHANGES TODAY THERE HAVE BEEN
MANY IMPORTANT UPDATES AT THE SUB REGULATORY LEVEL AND
PATIENTS OVER PAPERWORK INFORMS EVERYTHING WE DO.
AS HEALTHCARE PROVIDERS AND CLINICIANS YOU GUYS ARE THE
EXPERTS. YOU UNDERWENT EXTENSIVE
SCHOOLING AND CAME INTO THIS PROFESSION TO CURE ILLNESSES
AND SAVE LIVES NOT TO GET BOGGED DOWN IN NEVER ENDING
MORASS OF PAPERWORK. PORING OVER CONFUSING AND
DUPLICATIVE FORMS. WE ARE PROUD TO HAVE REDUCED
THAT BURDEN AND GIVE YOU MORE TIME WITH YOUR PATIENTS AND WE
ARE DETERMINED TO KEEP THE BALL ROLLING.
THAT’S WHY WE HAVE GATHERED YOU ALL HERE TODAY.
WE PRACTICED TODAY’S LISTENING SESSIONS TO ALIGN WITH 16
INITIATIVES INFORMED BY OUR FIRST ROUND OF DISCUSSIONS WITH
YOU. WE HAVE DELIVERED ON THE
CONCERNS THAT YOU VOICE THEN AND EAGER TO DO THE SAME FOR
WHAT YOU TELL US TODAY. WE ARE PARTICULARLY INTERESTED
IN YOUR THOUGHTS ON RELAXING OVERLY BURDENSOME CONDITIONS OF
PARTICIPATION, ADDRESSING RURAL HEALTH ISSUES AND TACKLING
PRIOR AUTHORIZATION. THAT LAST ONE, PRIOR
AUTHORIZATION IS PARTICULARLY IMPORTANT TO US AND MORE
BROADLY WE ARE DETERMINED TO EXPAND DRAMATICALLY OUR BURDEN
REDUCTION EFFORTS ACROSS NOT JUST TRADITIONAL MEDICARE BUT
ALL OUR OF OUR PROGRAMS. IT’S SAFE TO SAY YOU WILL BE
HEARING FROM CMS ON THESE ISSUES SO YOUR PERSPECTIVES
DURING OUR BREAKOUT SESSIONS WILL SHAPE OUR APPROACH.
I WANT TO TURNOVER THE MICROPHONE TO OUR FIRST GUEST
CONGRESSMAN BURGESS FOR SOME WORDS.
THANK YOU VERY MUCH. [ APPLAUSE ]
>>THANK YOU, ADMINISTRATOR VERMA.
IT’S ALWAYS A PLEASURE TO COME OVER AND JOIN YOU HERE AT THE
CITADEL OF HEALTH POLICY. MY CONGRESSIONAL OFFICE IS
DIRECTLY ACROSS THE STREET. IN FACT I CAN LOOK OUT MY
WINDOW AND SEE THE HUBERT HUMPHREY BUILDING ANY TIME OF
DAY OR NIGHT. I WANT YOU TO KNOW I FEEL I
HAVE DIRECT OVERSIGHT OVER THE SECRETARY OF HEALTH AND HUMAN
SERVICES. I JUST WANT TO SAY SECRETARY
VERMA, I APPRECIATE YOUR WILLINGNESS TO ENGAGE WITH ME
AND OTHER MEMBERS OF THE ENERGY AND COMMERCE COMMITTEE AND EVEN
WAYS AND MEANS COMMITTEE OVER THE COURSE OF YOUR TENURE AT
THE CENTER OF MEDICARE MEDICAID SERVICES.
HAVE YOU HAD AN OPEN DOOR POLICY THROUGH TWO SESSIONS OF
CONGRESS. I THINK THAT HAS SERVED, I KNOW
IT HAS SERVED ME WELL AND I HOPE YOU FEEL THE SAME WAY.
LAST WEEK THE ENERGY AND COMMERCE COMMITTEE, THE
SUBCOMMITTEE ON OVERSIGHT INVESTIGATIONS HELD A HEARING
AND IT WAS LIVELY AND INTERACTIVE AND ADMINISTRATOR
VERMA WAS ABLE TO SHARE WITH US SOME OF THE POSITIVE
DEVELOPMENTS THAT THE CENTER FOR MEDICARE AND MEDICAID
SERVICES HAS ACHIEVED THE LAST FEW YEARS.
YOU ARE ON YOUR SECOND ANNIVERSARY, THAT’S A GOOD
THING N.2017 THEY LAUNCHED THE PAPER — PATIENTS OVER
PAPERWORK INITIATIVE. I’M THANKFUL FOR PUTTING OUT
THE RECENT PROPOSED STARK LAW AND KICK BACK STATUTE REFORMS.
DR. BOUCHON AND I ARE PROBABLY THE ONLY ON CAPITOL HILL WHO
UNDERSTOOD WHAT THAT MEANT BUT THEY WERE WRITTEN YEARS AGO TO
REGULATE MEDICINE THAT NO LONGER EXISTS IN THIS COUNTRY.
IT’S GREAT NEWS FOR PATIENTS AND DOCTORS.
IT WILL ALLOW MORE PATIENT- CENTERED CARE, A STEP IN THE
RIGHT DIRECTION TO ALLOW DOCTORS TO BE DOCTORS.
AS A PHYSICIAN I HAVE EXPERIENCED FIRSTHAND THE
FRUSTRATION OF THE ELECTRONIC HEALTH RECORD, PRIOR
AUTHORIZATION AND OTHER MECHANISMS THAT COULD STAND
BETWEEN A DOCTOR PROVIDING THE BEST CARE FOR THEIR PATIENT.
I’M GLAD CMS HAS TAKEN ON SOME OF THESE ISSUES TO ALLEVIATE
AND REMOVE SOME HURDLES WE HAVE TO JUMP.
I APPRECIATE THE ADMINISTRATOR’S COMMITMENT TO
ADDRESS PRIOR AUTHORIZATION AT OUR HEARING LAST WEEK.
DOCTORS SHOULD BE MAKING CLINICAL CONDITIONS BASED ON
WHAT IS BEST FOR THEIR PATIENT AND NOT BE PREVENTED FROM
MAKING THAT THOSE DECISIONS BY A THIRD PARTY.
THANK YOU FOR THE HEARING. I HOPE IT WAS AS USEFUL TO YOU
AS US. NOW I WOULD LIKE TO TURN THIS
MICROPHONE OVER TO ANOTHER VALUABLE MEMBER OF THE HEALTH
SUBCOMMITTEE ON COMMITTEE OF ENERGY AND COMMERCE, DR. LARRY
BOUCHON. WHO WAS THE PRESIDENT OF THE
UNITED STATES THE LAST TIME THERE WAS A PHYSICIAN AS CHAIR
OF THE ENERGY AND COMMERCE COMMITTEE?
IT WAS ANDREW JACKSON. SO IT’S BEEN A LONG TIME.
>>THANK YOU VERY MUCH. I WANT TO ASSOCIATE MYSELF WITH
ALL THE COMMENTS DR. BURGESS JUST MADE.
HE REALLY OUTLINED THE SITUATION BUT I’M HERE, I
REALLY WANT TO THANK ADMINISTRATOR VERMA AND HER
TEAM FOR WHAT THEY ARE DOING. THIS IS A TREMENDOUS INITIATIVE
AND I WILL GO OVER WHY THIS IS IMPORTANT.
SOME OF THE THINGS DR. BURGESS SAID BUT I WILL TOUCH ON SOME
LIFESTYLE ISSUES FOR PHYSICIANS.
WHAT I’M HEARING IN MY HOMETOWN.
I ALSO WANT TO THANK ADMINISTRATOR VERMA AND HER
TEAM FOR HER ACCESSIBILITY AND OPENNESS AND WILLINGNESS TO
LISTEN AND LISTEN TO PEOPLE WHO ARE OUT THERE EVERYDAY TRYING
TO TAKE CARE OF PATIENTS. AND HONESTLY THEY ARE VERY
RESPONSIVE TO CONCERNS AND QUESTIONS THAT PRACTICING
PHYSICIANS HAVE EVERYDAY. IN REAL LIFE, THIS IS ONE OF
THE BIGGEST ISSUES I HEAR ABOUT FROM MY PHYSICIAN FRIENDS WHEN
I GO BACK. WHEN I SEE THEM AT RESTAURANTS,
THEY SAY I’M SPENDING MORE TIME LOOKING AT A COMPUTER SCREEN
THAN TAKING CARE OF PATIENTS. I REALLY CAN’T OVERESTIMATE THE
IMPORTANCE OF THIS TO THE QUALITY OF LIFE.
I MEAN PEOPLE ARE MAKING DECISIONS TO LEAVE MEDICINE, AS
EVERYONE KNOWS, EARLY IN THEIR CAREER.
AND WE ARE LOSING QUALITY PEOPLE.
WE ARE ALSO HAVING MORE DIFFICULTY TIME RECRUITING
PHYSICIANS INTO CERTAIN SPECIALTIES, CERTAIN AREAS THAT
ARE MORE BURDENSOME AND DIFFICULT TO MANAGE FROM AN
ADMINISTRATIVE STANDPOINT. SO THIS HAS REAL LIFE IMPACT ON
OUR ABILITY TO TAKE CARE OF PEOPLE.
HAVE I PHYSICIANS TELL ME THE YOUNGER DOCTORS WHEN THEY COME
HOME, ONCE THE KIDS ARE IN BED THEY GO BACK TO THEIR COMPUTER
SCREEN AND FINISH THEIR DAY’S WORK, THEY MAY SPEND AN HOUR OR
TWO IN THE EVENING FINISHING THE WORK THEY DID DURING THE
DAY. THIS IS A SUBSTANTIAL QUALITY
OF LIFE ISSUE WHICH IS VERY FRUSTRATING.
I VERY MUCH APPRECIATE WHAT IS BEING DONE AND WHAT CONTINUES
TO BE DONE IN THIS AREA. A COUPLE THINGS DR. BURGESS
TOUCHED ON WITH THE STARK LAW IS VERY IMPORTANT.
THANK YOU VERY MUCH FOR TRYING TO ADDRESS THAT AND CONTINUING
TO WORK ON ELECTRONIC HEALTH RECORD EFFICIENCIES AND TRYING
TO A MORE INTEROPERABLE SYSTEM THAT WORKS FOR EVERYONE.
THIS IS ANOTHER CRITICAL ISSUE THAT FRUSTRATES PROVIDERS,
ESPECIALLY IN COMMUNITIES LIKE MINE WHO HAVE TWO HOSPITAL
SYSTEMS WITH TWO HEALTH RECORD SYSTEMS BUT THE DOCTORS GO TO
BOTH HOSPITALS AND IT’S CONFUSING AND PATIENTS GO TO
BOTH HOSPITALS MANY TIMES. SO THANK YOU FOR THAT WORK THAT
IS ONGOING. BUT AGAIN, AS A PRACTICING
PHYSICIAN, THIS INITIATIVE WHEN IT CAME OUT A COUPLE YEARS AGO
I REALLY FELT WAS ONE OF THE MOST IMPORTANT THINGS WE COULD
TRY TO ADDRESS FOR OUR HEALTHCARE SYSTEM.
THE LAST THING I WANT TO TOUCH ON IS THE COST TO THE SYSTEM OF
BURDENSOME ADMINISTRATIVE HURDLES.
THE COST OF THAT ARE GOING UP AND HAVE GONE UP.
AND SO AGAIN, NOT ONLY IS THIS ABOUT PHYSICIAN LIFESTYLE AND
ABOUT TAKING CARE OF PATIENTS, THIS IS LEGITIMATELY ABOUT HOW
DO WE PAY FOR A HEALTHCARE SYSTEM GOING INTO THE FUTURE.
HOW DO WE MAKE SURE ALL OF US HAVE ACCESS TO QUALITY
AFFORDABLE HEALTHCARE, IF WE DON’T ADDRESS THE
ADMINISTRATIVE BURDEN IN AN AGGRESSIVE WAY WE WILL HAVE
MORE AND MORE CHALLENGES IN THAT AREA.
WITH THAT, THANK YOU VERY MUCH, ADMINISTRATOR VERMA AND YOUR
TEAM FOR ALL YOU ARE DOING AND AGAIN, THANK YOU FOR THE
OPENNESS AND THE OPEN DOOR POLICY THAT YOU HAVE.
AND FOR LISTENING TO PROVIDERS OUT THERE WHO ARE EVERYDAY
WAKING UP, JUST TRYING TO FIGURE OUT THE BEST WAY TO TAKE
CARE OF PATIENTS. THANK YOU.
>>ALL RIGHT. UP NEXT WE WILL HEAR FROM THREE
CLINICIANS. THEY ARE DR. RYAN WHISTLER,
CLINICAL COORDINATOR, JOHNS HOPKINS, RODGER WELLS PHYSICIAN
ASSISTANT LEXINGTON NEBRASKA REGIONAL HEALTH CENTER AND DR.
STEWART BEADY, PharmD ASSOCIATE PROFESSOR.
DR. WHISTLER, WILL YOU PLEASE COME UP?
IF YOU WOULD JUST FOLLOW ONE AFTER ANOTHER, THAT WOULD BE
GREAT.>>THANK YOU ADMINISTRATOR
VERMA AND THE TEAM FOR INVITING ME TO SPEAK ABOUT MY
EXPERIENCE. AS A MEMBER OF THE HEALTHCARE
COMMUNITY WE KNOW LACK OF ACCESS TO PRESCRIBED MEDICATION
CAN BE A SIGNIFICANT BARRIER FOR OUR PATIENTS IN MAINTAINING
THEIR HEALTH. IN TRANSPLANT RECIPIENTS THE
PATIENT POPULATION I WORK WITH, WE KNOW ANY MISDOSE CAN
INCREASE THE LIKELIHOOD OF ORGAN DONOR AND NEED FOR
TRANSPLANTATION. WHILE REPORTED RATES VARY A
JOURNAL PUBLISHED FOUND UP TO A THIRD OF PRESCRIPTIONS IN THE
EMERGENCY ROOM GO UNFILLED. BEDSIDE DELIVERY PROGRAMS HAVE
BEEN RECOGNIZED AS A PREFERRED METHOD THUS LOWERING THE
LIKELIHOOD OF MISSED DOSES I MENTIONED A MOMENT AGO.
AT THE JOHNS HOPKINS OUTPATIENT PHARMACIES, TEAMS DELIVER TO
ALL PATIENTS RECEIVING AN ORGAN TRANSPLANT WITH PURPOSE, SIDE
EFFECTS DOSING SCHEDULE AND SPECIAL ADMINISTRATION
INSTRUCTIONS AND ASSIST IN SETTING UP A PILL BOX WHICH
FACILITATES ADHERENCE, CONSISTING OF MULTIPLE TABLETS
AND PILLS AT EACH DOSING TIME THROUGHOUT THE DAY.
PRIOR TO THE REGULATION CHANGE PART OF THE PATIENTS OVER
PAPERWORK EFFORTS OUR SERVICE WAS NOT ABLE TO PROVIDE ANTI
REJECTION MEDICATIONS AS PART OF THE DISCHARGE PROCESS.
CMS REGULATIONS RESTRICTED THIS TO ADDRESS ON FILE WITH
MEDICARE W. THIS CHANGE WE ARE NOW ABLE TO INCLUDE THESE ANTI
REJECTION MEDICATIONS AS PART OF THE PROCESS THERE BY
ENSURING IMMEDIATE ACCESS TO THESE CRITICAL MEDICATIONS
AFTER DISCHARGE. AS MY TEAM MEETS WITH PATIENTS
IN PREPARATION WITH DISCHARGE TO EDUCATE ABOUT THE NEW
MEDICATION REGIMENS WE CONTINUE TO HEAR HOW THANKFUL THEY ARE
TO HAVE MEDICATIONS IN HAND, IN A PILL BOX AS THEY LEAVE THE
HOSPITAL. JUST EARLIER THIS MONTH I WAS
IN A HOSPITAL ROOM OF A PATIENT WHOSE HOME WAS SEVERAL HOURS
AWAY FROM JOHNS HOPKINS. SHE TOOK TIME TO THANK ME FOR
PROVIDING HER MEDICATIONS AS SHE WENT THROUGH THE FINAL
STEPS OF PREPARING FOR DISCHARGE.
SHE TOLD ME I DON’T KNOW HOW I COULD HAVE HANDLED GOING TO A
PHARMACY AND FULFILLING THESE MEDICATIONS THIS EVENING AFTER
ALL I HAVE BEEN THROUGH AND ALL I HAVE TO STILL DO ONCE I
LEAVE. THANK YOU FOR MAKING SURE I
HAVE ALL MY MEDICATIONS THIS IS ONE LESS THING I HAVE TO WORRY
ABOUT. I KNOW SHE DIDN’T KNOW IT BUT
PATIENTS OVER PAPERWORK MADE THIS POSSIBLE FOR HER AND
HUNDREDS OF OTHER PATIENTS AND WILL CONTINUE TO DO SO FOR
THOUSANDS OF OTHER TRANSPLANT RECIPIENTS.
THANK YOU. [ APPLAUSE ]
>>GOOD MORNING, MY NAME IS RODGER WELLS, I’M A PHYSICIAN
IN LEXINGTON NEBRASKA, A REAL COMMUNITY WITH HEALTH CLINIC.
I HAVE HAD THE HONOR OF WORKING IN RURAL HEALTHCARE FOR 30
YEARS AND I WOULD LIKE TO GIVE YOU A PERSPECTIVE WHAT OUR JOB
IS. I STARTED WORKING IN AN ERA
WHERE THERE WAS TREMENDOUS FREEDOM.
PROVIDERS LOVED THEIR WORK, THEY HAD EMPATHY AND PERSONAL
GIVING FOR APPROPRIATE CARE TO PATIENTS IN THEIR COMMUNITY.
DURING MY CAREER I HAVE SEEN A DRAMATIC CHANGE.
CHANGE IN THE DELIVERY OF MEDICAL CARE.
STARTED WITH NO ALGORITHMS, NO PRACTICE GUIDELINES, NO
PREAUTHORIZATION, MINIMAL DOCUMENTATION TO BURDENSOME
GRIND. SOME ESTIMATE 47% WORKDAY OF
ADMINISTRATIVE TIME INSTEAD OF CARING FOR PATIENTS.
IN RURAL AMERICA THE BURDEN IS MORE CONCERNING BECAUSE THE
EXODUS OF PROVIDER PRESENCE FROM THE RURAL HEALTHCARE IN
THE FUTURE IS EXPECTED TO BE WORSE JUST DUE TO BURN OUT.
THERE’S ALREADY BEEN 118 SMALL HOSPITALS CLOSED AND 388
CLOSURES, PRESENTLY ABOUT 18% OF THE U.S. POPULATION RESIDES
IN RURAL AMERICA BUT ABOUT 10% OF PHYSICIANS PRACTICE IN RURAL
AMERICA. AND IT’S MUCH DIFFERENT THAN AN
URBAN ENVIRONMENT. RURAL BENEFICIARIES ARE
GENERALLY OLDER, SICKER, HAVE MORE CO MORBIDITY, LOWER
SOCIOECONOMIC, HIGHER MENTAL HEALTH ISSUES, DISEASE AND DRUG
ABUSE. LESS ADMINISTRATIVE SUPPORT,
THE COMMUNITY IS BASED MORE ON ZIP CODE THAN HEALTHCARE
PROVIDER ABILITY. RECENTLY ONE DAY WHILE WORKING
IN OUR LOCAL EMERGENCY DEPARTMENT I SAW THIS.
A FALL WITH LOSS OF CONSCIOUSNESS AND FRACTURES, A
MISCARRIAGE IN PREGNANCY AND GAL BLADDER REQUIRING TRANSFER
BECAUSE WE DIDN’T HAVE A SURGEON.
THEY HAD TO BE REMOVED. A PATIENT IN RESPIRATORY
FAILURE NEEDED TRANSFER TO SPECIALIST.
ACUTE APPENDICITIS IN A 3-YEAR- OLD THAT NEED TODAY BE
TRANSFERRED BECAUSE WE DIDN’T HAVE A SURGEON.
CONSULTATION FOR MANY OTHERS IN ONE DAY.
THESE CASES REQUIRE MENTAL HEALTH RECORD INTEROPERABILITY,
PATIENT DATA INFORMATION, BY USING TOOLS THEY ARE TREATED BY
THE APPROPRIATE PROVIDER WITH THE APPROPRIATE LEVEL OF CARE,
AT THE APPROPRIATE TIME. NOW WITH THE CHANGES DUE TO THE
CMS PATIENTS OVER PAPERWORK PROGRAM WE ARE EXPERIENCING
IMPROVEMENTS IN THE HEALTHCARE DELIVERY MODELS IN MANY RURAL
SETTINGS. LET’S SEE HOW.
IN RURAL NEBRASKA WE SEE TRAUMA CARE ASSISTANCE IN THE
EMERGENCY, INPATIENT TO REDUCE PROVIDER CALL BURDEN, SPECIALTY
CONSULTS, ACUTE HEART ATTACKS CONGESTIVE HEART FAILURE AND
PREMATURE DELIVERY OF A 28 WEEK MOTHER.
WE SEE RANGING FROM DERMATOLOGY TO PULMONARY.
THEY ARE ADOPTING NEW EVALUATION AND MANAGEMENT CODES
BECAUSE OF LACK OF TECHNICAL SUPPORT AND FINANCES BUT CMS
MODIFIED WITH BONUS POINTS SUCH AS FOUND IN QUALITY PERFORMANCE
CATEGORY SCORERS. RURAL OUT CLINICS NOW, IF THEY
HAVE AN APPROPRIATE RELATIONSHIP WITH THE HOSPITAL
CAN SUBMIT MIXED SCORING. THIS IS NECESSARY TO ENTICE THE
PRACTICES, TO REDIRECT FINANCIAL RESOURCES.
THESE BENEFITS ALLOW PROVIDERS TO REFOCUS THEIR RESOURCES AND
DEVELOP PRACTICE MODELS FOR BETTER OUTCOMES.
IN CLOSING, I BELIEVE THE PATIENT EXPERIENCE, THE PATIENT
OUT COMES, THE PROVIDER LOSS, THE SOCIAL DETERMINANTS OF
HEALTHCARE ALL HAVE A BETTER PROGNOSIS WITH THE NEW HUMAN
CENTERED DESIGN AND MODIFICATION AND IMPLEMENTATION
WITH THE CMS PATIENTS OVER PAPERWORK PROGRAM.
WE LOOK FOR THE OPPORTUNITY TO PRACTICE MEDICINE IN RURAL
AMERICA. THANK YOU VERY MUCH.
[ APPLAUSE ]>>MY NAME IS STEWART BADY.
I WANT TO THANK YOU FOR ALLOWING ME TO BE HERE.
REPRESENTING PHARMACISTS FOR THE PATIENTS OVER PAPERWORK
INITIATIVE. PHARMACISTS SHARE AND
APPRECIATE CMS’S GOAL TO REDUCE BURDEN TO PROVIDE PATIENT
CENTER CARE, INNOVATIONS AND OUT COMES.
I HAVE PRACTICED AS A PHARMACIST WITHIN OHIO STATE
UNIVERSITY. OUR SEVEN PRIMARY CLINICS
INCLUDE A ROBUST TEAM OF HEALTHCARE PROFESSIONALS
WORKING TOGETHER TO CARE FOR OVER 70,000 PATIENTS IN CENTRAL
OHIO. CMS LED PRIMARY PLUS
INITIATIVE. OUR CLINICIANS IN LEADERSHIP
BELIEVE STRONGLY IN THE VALUE OF PHARMACISTS AND THIS HAS
ALLOWED US TO EMBED A PHARMACIST IN EACH OF OUR SEVEN
PRACTICE SITES. THE ROLE IS TO FOCUS ON THE
HIGHEST RISK PATIENTS AS THEY TEND TO BE ON THE HIGHEST RISK
MEDICATIONS. PHARMACISTS HAVE ROLES IN
TRANSITIONAL MANAGEMENT CARING FOR COMPLEX PATIENTS,
UNCONTROLLED DIABETES, HYPERTENSION AND BEHAVIORAL
HEALTH ISSUES. I WILL BRIEFLY DISCUSS TWO
PATIENT ENCOUNTERS. THE FIRST IS A 70-YEAR-OLD MALE
STRUGGLING TO REDUCE HIS DIABETES.
I REVIEWED HIS CHART FOR KEY ELEMENTS OF HIS MEDICAL HISTORY
AND CLARIFIED HE HAD DIABETES FOR 15 YEARS, EATS A STANDARD
MEDITERRANEAN DIET AND SUFFERS FROM KNEE PAIN.
HIS PORTIONS ARE LARGER THAN THEY SHOULD BE AND OFTEN
DOESN’T TAKE DIABETES MEDICATION DUE TO COST ISSUES.
I SPENT MORE THAN 75% OF MY TIME DEVELOPING A PLAN FOR THIS
PATIENT INCLUDING HOW TO NAVIGATE RAMADAN WITH DIABETES.
IN NINE MONTHS, I HIGHLIGHT ONLY ONE OFFICE VISIT WITH THE
PHYSICIAN, IT’S GO FROM 12.5% TO 8.3% A SIGNIFICANT DROP
BECAUSE THE PHARMACIST HAS BEEN ALLOWED TO BE INVOLVED IN THAT
CARE. LET ME ALSO MENTION A 56-YEAR-
OLD AFRICAN AMERICAN FEMALE ON MEDICARE FOR LONG TERM
DISABILITY. IDENTIFIED ON CHRONIC DOSES OF
OPIOIDS AND REFERRED FOR A NALOXONE TRAINING SESSION.
ALSO DIAGNOSED WITH DEPRESSION AND ANXIETY, STARTED ON
MEDICATION AND REFERRED TO EMBEDDED SOCIAL WORKER FOR
COUNSELING. I VISITED AT THE END OF THE
FIRST COUNSELING SESSION AND ABLE TO EDUCATE ON THE
APPROPRIATE USE OF NALOXONE, SHE WAS RECEIVING PARTIAL
RESPONSE AND ABLE TO TITRATE TO A HIGHER DOSE.
THIS HAPPENED OUTSIDE A STANDARD OFFICE VISIT ALLOWING
HER PRIMARY CARE PROVIDER TO CREATE ACCESS FOR OTHER
PATIENTS. I WAS ABLE TO ACCOMPLISH MY
PORTION OF THIS VISIT IN LESS THAN TEN MINUTES BECAUSE I
DIDN’T NEED TO FOCUS ON REGATHERING HISTORY PREVIOUSLY
OBTAINED IN THE CHART. I CAN SHARE MANY INSTANCES.
WHEN I SPEAK AT CONFERENCES AROUND THE COUNTRY THE ISSUE
HASN’T BEEN ON WHAT PHARMACISTS CAN DO TO HELP BUT HOW CAN
PRACTICES FIND A WAY TO RESOURCE THEIR INVOLVEMENT.
I ENCOURAGE CMS TO FACILITATE SUSTAINABLE MECHANISMS FOR
PHARMACISTS AND TEAM BASED MODELS.
I CAN’T THANK CMS ENOUGH FOR ALLOWING OUR TEAM TO REDUCE
ADMINISTRATIVE BURDENS. THANK YOU FOR YOUR TIME.
>>OUR NEXT TWO SPEAKERS, DR. BARBARA LEVY.
THE SECOND IS DR. JANICE ORLOWSKI AT DOUBLE A.M.C.
>>THANK YOU SO MUCH FOR THE INVITATION.
IT’S A GREAT PLEASURE TO BE WITH YOU.
MY NAME IS BARBARA LEVY, OBSTETRICIAN GYNECOLOGIST AND
CO-CHAIR OF A.M.A. C.P.T. RUCK EVALUATION MANAGEMENT WORK
GROUP THAT WAS CONVENED TO TRY TO HELP US FIGURE OUT A BETTER
WAY TO DOCUMENT THAT REDUCE THE BURDEN.
I’M HERE ON BEHALF OF THE MEDICAL ASSOCIATION AND WE ARE
REALLY THRILLED TO BE PARTNERS WITH CMS IN FORWARDING THIS TO
REDUCE BURDEN ON PROVIDERS. FOR EVERY HOUR WE SPENT, WE
SPEND TWO HOURS IN ADMINISTRATIVE WORK.
AND WE DIDN’T GO TO MEDICAL SCHOOL TO DO PAPERWORK.
MOST OF US, I WOULD VENTURE TO SAY ALL OF US WENT TO MEDICAL
SCHOOL TO TAKE CARE OF PATIENTS.
THEY NEED AND DESERVE MORE OF OUR TIME, OF OUR EFFORT, OF OUR
ENERGY. AND THESE INITIATIVES ARE WELL
POSITIONED TO HELP US DO THAT. WE NEED TO BE FREED OF THE
EXCESSIVE ADMINISTRATIVE BURDENS TO DEVOTE THAT TIME TO
PATIENT CARE. THAT’S WHY THE A.M.A. ADVOCACY
WORK IS FOCUSED ON REMOVING OBSTACLES THAT OFTEN INTERFERE
WITH TAKING CARE OF PATIENTS. BECAUSE OF THIS WORK, THEY
STRONGLY SUPPORT ADMINISTRATOR VERMA, THANK YOU, AND THE
PATIENTS OVER PAPERWORK INITIATIVE.
AS CO-CHAIR OF THIS WORK GROUP ON MANAGEMENT CODING AND
SERVICES, THAT’S A DIRECT RESULT OF THE PATIENTS OVER
PAPERWORK INITIATIVE AND WE ARE SO GRATEFUL FOR THAT
OPPORTUNITY. WE HAVE ENGAGED WITH
ADMINISTRATOR VERMA’S STAFF THROUGHOUT THE PROCESS AND IT’S
BEEN A GREAT COLLABORATION. FOR YEARS THE PHYSICIAN
COMMUNITY HAS STRUGGLED WITH BURDENSOME GUIDELINES FOR
REPORTING AND EVALUATION MANAGEMENT SERVICES.
IN 2018 UNDER VERMA’S LEADERSHIP, CMS PROVIDED
OPPORTUNITY TO ACHIEVE REAL BURDEN RELIEF FOR AMERICAN
PHYSICIANS AND WE CAN SPEND MORE TIME CARING FOR OUR
PATIENTS. KNOWING ADMINISTRATOR VERMA’S
COMMITMENT TO ADDRESSING THIS CRITICAL ISSUE IN AUGUST 2018
THE LEADERSHIP OF THE EDITORIAL PANEL AND SPECIALTY SOCIETY
R.D.S. COMMITTEE, THAT’S REALLY A MOUTHFUL CONVENES IT’S WORK
GROUP TO CREATE NEW STRUCTURE FOR EVALUATION AND MANAGEMENT
SERVICES. OVER THE COURSE OF THE NEXT
SEVERAL MONTHS THE WORK GROUP CONVENED EIGHT OPEN STAKEHOLDER
CALLS OR MEETINGS WHERE ON AVERAGE NEARLY 300 INDIVIDUALS
PARTICIPATED AND CMS STAFF PARTICIPATED IN EVERYONE OF
THOSE CALLS AND MEETINGS. IN BETWEEN THE CALLS AND
MEETINGS THE WORK GROUP CONDUCTED FIVE SURVEYS DESIGNED
TO COLLECT TARGETED FEEDBACK FROM ALL INTERESTED PARTIES.
AND IT WAS REALLY DUE TO ADMINISTRATOR VERMA’S
COMMITMENT TO THIS AND HER DETERMINATION THAT WE GOT THE
ATTENTION AND INVOLVEMENT FROM ALL STAKEHOLDERS MEDICAL
SOCIETIES AND PAYERS. AND THROUGHOUT THE PROCESS WE
KEPT CMS INFORMED OF THE DEVELOPMENTS.
THE NEW FRAMEWORK WHICH HAS BEEN CRAFTED PROVIDES
PHYSICIANS WITH EASIER OPTIONS. WE CAN REPORT EITHER BASED ON
TOTAL TIME WITH PATIENTS OR BASED ON THE CARE THAT WE ARE
DELIVERING ON THE MEDICAL DECISION MAKING THAT GOES INTO
TAKING CARE OF PATIENTS AND WE NO LONGER HAVE TO CHECK BOXES
AND TALK ABOUT NUMEROUS CUMBERSOME DOCUMENTATION CASES
THAT WE NEED TO DO. SO ULTIMATELY AFTER A GREAT
DEAL OF WORK AND EFFORT AND COLLABORATION THE CPT EDITORIAL
PANEL ADOPTED THE WORK GROUP’S RECOMMENDATIONS TO IMPLEMENT A
NEW FRAMEWORK FOR SELECTING AND DOCUMENTING EVALUATION AND
MANAGEMENT OFFICE VISITS. THE WORK THEN MOVED TO THE
R.B.F. UPDATE COMMITTEE WHICH ULTIMATELY SENT RECOMMENDATIONS
TO CMS FOR EVALUATION OF MAY OF 2018.
THESE RECOMMENDATIONS RECOGNIZED PRIMARY CARE AND ALL
PHYSICIANS WHO PROVIDE CARE TO PATIENTS IN THE OFFICE SETTING.
WE AREN’T CERTAIN ABOUT THE FINAL OUTCOME OR WHAT THE FINAL
POLICY WILL BE BUT HOWEVER WE ARE REALLY HOPEFUL THAT CMS
WILL FULLY IMPLEMENT THE C.P.P. RUCK WORK PRODUCT IN 2021.
THE AMA IS CONFIDENT THIS NEW OFFICE VISIT REPORTING
FRAMEWORK WILL LESSEN THE DOCUMENTATION BURDEN FOR
PROVIDERS AND ALLOW THEM TO SPEND MORE TIME WITH THEIR
PATIENTS. I WANT TO THANK ADMINISTRATOR
VERMA AN THE PATIENTS OVER PAPERWORK INITIATIVE FOR THE
COMMITMENT TO REDUCING THIS BURDEN.
THANK YOU.>>GOOD MORNING.
I’M JANICE, THE CHIEF HEALTHCARE OFFICER.
I’M A PRACTICING NEPHROLOGIST GIST.
ON BEHALF OF OUR 154 ACCREDITED U.S. MEDICAL SCHOOLS NEARLY 400
MAJOR TEACHING HOSPITALS AND HEALTH SYSTEMS, OUR FACULTY
RESIDENTS AND STUDENTS, I THANK YOU FOR THE OPPORTUNITIES TO
SPEAK ON THE IMPORTANT ISSUE OF REDUCING REGULATORY BURDEN.
THE A.A.M.C. STRONGLY SUPPORTS ADMINISTRATOR VERMA AND CMS’S
PATIENTS OVER PAPERWORK INITIATIVE WHICH STRESSES THE
IMPORTANCE OF REDUCING BURDENS TO ALLOW PHYSICIANS HOSPITALS
AND OTHER HEALTHCARE PROFESSIONALS TO DEVOTE MORE
TIME TO PATIENT CARE. AND APPRECIATE CMS’S COMMITMENT
BY FOCUSING ON PATIENT CENTERED CARE.
SPECIFICALLY CMS HAS ALREADY PROVIDED SOME SIGNIFICANT
REGULATORY RELIEF TO HOSPITALS AND PHYSICIANS, I JUST WANT TO
NOTE A FEW. THE A.A.M.C. APPRECIATES THE
REVISION TO THE MANUAL INSTRUCTIONS TO ALLOW TEACHING
PHYSICIANS TO VERIFY IN THE MEDICAL RECORDS ANY STUDENT
DOCUMENTATION OF BILLABLE SERVICES RATHER THAN REQUIRING
THE ATTENDING PHYSICIANS TO REDOCUMENT THE WORK.
THOUGH WE HAVE TALKED ABOUT THE PHYSICIANS WORK BEING REDUCED
WITH THIS. IF YOU HAVE EVER READ
ELECTRONIC HEALTH RECORD IT’S NEARLY IMPOSSIBLE WITH ALL THE
REDOCUMENTATION, SO THESE REALLY MAKE THE PATIENT RECORD
EASIER TO FOLLOW AND THEREFORE PATIENT CARE BETTER.
AND APPRECIATES CHANGES AFFECTED IN 2019 THAT REDUCED
BURDEN ON TEACHING PHYSICIANS BY STATING THAT THE PRESENCE OF
THE TEACHING PHYSICIAN DURING PROCEDURES AND E.M.N. SERVICES
MAY BE DEMONSTRATED BY THE NOTES IN THE MEDICAL RECORDS
EITHER BY PHYSICIAN, RESIDENTS OR NURSE.
IN ADDITION THE PROPOSAL IN 2020 TO INCLUDE MEDICAL
STUDENTS AND OTHERS. WHILE WE ARE PLEASED WITH THESE
REFINEMENTS WE ALSO BELIEVE THERE ARE ADDITIONAL CHANGES
THAT COULD BE MADE TO REDUCE BURDEN FOR TEACHING PHYSICIANS
IN THE FUTURE AND WE PROMISE TO WORK WITH C.M.S. TO REVISIT THE
TEACHING REGULATIONS AND GUIDELINES ESTABLISHED IN 1995,
MORE THAN 20 YEARS AGO. SO IT’S TIME FOR US TO CHANGE
THESE SO THAT THEY REFLECT THE WORK THAT WE DO TODAY AND THE
WORK THAT WE DO IN TEAMS. CMS ALSO IMPLEMENTED TWO
SIGNIFICANT DOCUMENTATION CHANGES IN 2019 WE BELIEVE WILL
LEAD TO IMPROVED PATIENT CARE AND BETTER ALIGN WITH CURRENT
MEDICAL PRACTICE AND USE OF THE ELECTRONIC HEALTH RECORD.
INCLUDE REQUIRING PHYSICIAN TO FOCUS DOCUMENTATION ONLY ON
WHAT HAS CHANGED SINCE THE LAST VISIT RATHER THAN REDOCUMENTING
A WHOLE SERIES REQUIRED ELEMENT.
AND IN ADDITION TO THE PHYSICIAN DOES NOT NEED TO
REDOCUMENT CHIEF COMPLAINT ILLNESS ALREADY DOCUMENTED IN
THE MEDICAL RECORD BY OTHER CLINICAL PROVIDERS.
THESE CHANGES ALLOW PHYSICIANS TO EXERCISE THEIR CLINICAL
JUDGMENT AND DISCRETION TO DOCUMENT WHAT IS CLINICALLY
RELEVANT AND MEDICALLY NECESSARY FOR THE CARE OF THE
PATIENT. IN THE PROPOSED 2020 FEE
SCHEDULE RULES CMS PROPOSES CHANGES TO CODING,
DOCUMENTATION AND CODING EFFECTIVE IN 2021.
WE ALSO SUPPORT FINALIZING THE POLICY FOR 2021 ALLOWING
PHYSICIANS TO DOCUMENT BASED ON MEDICAL DECISION MAKING OR TIME
WOULD HELP ALLEVIATE PROBLEMS OF DOCUMENTATION LEAD TO
IMPROVED PATIENT CARE AND CURRENTLY ALIGN WITH PRACTICES
AND CURRENT USE OF THE ELECTRONIC MEDICAL RECORD.
WE APPLAUD CMS FOR ITS EFFORTS TO REDUCE REGULATORY BURDEN AND
WE BELIEVE THERE’S MORE WE CAN DO TO CHANGE THAT WOULD HELP TO
REDUCE THE BURDEN. WE ARE LOOKING AT WAYS TO
CONTINUE DOCUMENT OR ADJUSTING THE DOCUMENTATION FOR SOCIAL
DEMOGRAPHIC FACTORS, PAYMENT INEQUALITY PROGRAMS.
REDUCE BARRIERS TO TELEHEALTH AND REDUCING COMPLEXITY AND
ALIGN THE MULTIPAYMENT PROGRAMS ACROSS PAYERS.
WE CONTINUE TO WELCOME THE OPPORTUNITY TO WORK WITH CMS ON
FUTURE INITIATIVES ON BURDEN REDUCTION AND WE THANK YOU FOR
THE WORK YOU HAVE ALREADY DONE. [ APPLAUSE ]
>>I WOULD LIKE TO THANK ALL THE SPEAKERS TODAY.
IF WE COULD GIVE ANOTHER ROUND OF APPLAUSE, THAT WOULD BE
FANTASTIC. IT’S SO GREAT TO HEAR PATIENTS
OVER PAPERWORK HAS ALREADY HAD POSITIVE EFFECT ON THE MEDICAL
COMMUNITY. THANK YOU AND THANK MANY OF THE
OTHERS IN THE AUDIENCE WHO HAVE CONTRIBUTED IN SOME WAY TO
INFORMING THE WORK WE ARE DOING.
WHEN WE STARTED PATIENTS OVER PAPERWORK WE REALIZED CMS
NEEDED TO CHANGE THE WAY WE OPERATED TO ESTABLISH THE
PROGRAM EFFECTIVELY. THERE’S THREE THINGS WE HAD TO
DO IN PARTICULAR. WE HAD TO COLLABORATE ACROSS
THE AGENCY AND COMPONENTS AND MORE SO ACROSS THE PROGRAMS TO
MAKE SURE WE ARE PRIORITIZING THE BURDEN ISSUES WE SHOULD BE
FOCUSING ON AND MAKE SURE ONE PART OF CMS IS NOT DECREASING
BURDEN AND INCREASING BURDEN FOR ANOTHER PART OF THE PROGRAM
AT THE EXACT SAME TIME, WE DO THIS BY ESTABLISHING A STEERING
COMMITTEE, MADE OF CMS EXECUTIVES TO DO JUST THAT.
TO HEAR AND UNDERSTAND THE INPUT WE RECEIVE FROM THE
EXTERNAL COMMUNITY. FIGURING OUT WHAT WE CAN DO AND
WORKING TOGETHER TO MAKE SURE WE ARE CONSISTENT IN OUR
APPROACH AS WE ADDRESSING THE BURDENS.
THE SECOND WHICH IS ABSOLUTELY CRITICAL TO GET THIS RIGHT IS
TO HEAR FROM THE MEDICAL COMMUNITY.
IT WOULD BE GREAT TO TALK TO EACH OTHER ABOUT WHAT WE
UNDERSTAND ABOUT BURDENS IN THE EXTERNAL COMMUNITY AND WHAT WE
CAN DO ABOUT THEM BUT IT’S ABSOLUTELY CRITICAL TO TALK TO
FOLKS IN THE MEDICAL FACILITIES, CLINICAL PRACTICES,
IN THE HEALTH PLANS FOR THAT MATTER OR OTHER HEALTHCARE
STAKEHOLDERS TO UNDERSTAND HOW OUR RULES IMPACT THEIR DAY-TO-
DAY OPERATIONS WHETHER IT’S MAKING THEM BETTER.
WE GET SOME INPUT ON THAT SOMETIMES TOO.
BUT REALLY, HOW IT’S IMPEDING GOOD CARE DELIVERY OR MAYBE
EVEN INNOVATION. SO EXTERNAL INPUT IS CRITICAL.
ADMINISTRATOR VERMA MENTIONED WE GET STAKEHOLDER INPUT IN A
VARIETY OF WAYS TO REQUEST MORE INFORMATION, LISTENING SESSIONS
AND INTERVIEWS. BUT THE MOST CRITICAL THING IS
GETTING CMS STAFF OUT OF OUR BUILDINGS AND INTO PROVIDER
FACILITIES AND CLINICAL PRACTICES AND OBSERVE FROM AND
TALK WITH FRONT LINE STAFF TO UNDERSTAND WHERE THE CHALLENGES
REALLY ARE. WE KNOW FOR EXAMPLE THAT IT’S
HARD TO FIND SOME OF OUR DOCUMENTATION REQUIREMENTS SO IT’S
NOT ALWAYS CLEAR EXACTLY WHO TO CALL AND WHEN TO CALL, WE KNOW
THAT. BUT WHEN YOU SIT NEXT TO AN
ADMINISTRATIVE STAFF PERSON WHO HAS 40 STICKIES AROUND THEIR
COMPUTER THAT IS A LINK TO NOT JUST OUR RESOURCES BUT THE
RESOURCES OF THE OTHER HEALTH PLANS THEY HAVE TO INTERACT
WITH AS WELL. THAT HAS A DIFFERENT KIND OF
IMPACT AND IF A EMPHASIZES WHAT IS REALLY IMPORTANT.
IT FEELS LIKE SOMETHING WE CAN CHANGE.
WE HAVE OUR GOAL NEXT YEAR IS TO GET AT LEAST 2000 MORE
STAKEHOLDERS INVOLVED IN PROVIDING US INPUT.
LAST YEAR PROBABLY 3,000. WE ALSO HAVE SEVERAL HUNDRED
CMS STAFF INVOLVED AND WE WANT TO DOUBLE OR EVEN TRIPLE THAT
NEXT YEAR TO GET THEM OUT THERE AND TALK TO PEOPLE DIRECTLY.
SO TO GIVE YOU A FLAVOR FOR THE EXPERIENCE OF THE CMS STAFF WE
WILL SHOW YOU A BRIEF VIDEOTAPE AND WE HAVE SHEILA BLACKSTOCK
WHO WILL TALK TO YOU DIRECTLY ABOUT HER EXPERIENCE.
[ VIDEO ]>>I’M SHEILA BLACKSTOCK.
FOR THOSE WHO DON’T KNOW WHAT WE DO, CONDITIONS FOR
REQUIREMENT AND REQUIREMENTS FOR PARTICIPATION, SO MANY OF
THE THINGS ARE YOU TALKING ABOUT TODAY.
I HAVE BEEN INVOLVED WITH PATIENTS OVER PAPERWORK PRETTY
MUCH SINCE ITS INCEPTION IN VARIOUS WAYS.
I WANT TO THANK YOU FOR CONTINUING TO ENGAGE ME, I HOPE
TO CONTINUE TO PARTICIPATE IN THE INITIATIVE BECAUSE IT’S
BEEN INVALUABLE FOR ME. THERE ARE MANY WAYS THAT’S
TRUE. I WILL FOCUS QUICKLY ON ONE IN
THE SAKE OF TIME. AND THAT IS THAT OPPORTUNITY TO
GO OUT AND VISIT PROVIDERS AND SPEAK DIRECTLY WITH FRONT LINE
HEALTHCARE DELIVERERS. I AM A NURSE BY BACKGROUND.
I HAVE DONE THIS. BUT I HAVE ALSO BEEN IN THE
BUREAUCRATIC SETTING FOR A LONG TIME.
SO IT WAS VERY VALUABLE TO GO TO A CRITICAL ACCESS HOSPITAL
AND TALK TO THE NURSE WHO FILLS HALF A DOZEN ROLES TO THE
DISCHARGE PLANNER WHO HAS TO FIGURE OUT HOW TO ACCESS ALL
THE RIGHT SERVICES IN AN UNDERSERVED AREA TO MAKE SURE
HER PATIENTS GO HOME SAFELY. TO THE PEOPLE IN THE EMERGENCY
ROOM WHO DEAL WITH ALL KINDS OF THINGS I MIGHT NOT NECESSARILY
HAVE THOUGHT ABOUT THEM DEALING WITH IN A RURAL SETTING.
TO GO TO A HOME HEALTH SETTING AND SEE HOW HARD IT IS FOR THE
PERSON WHO PUTS ALL THE CLAIM INFORMATION IN THE SYSTEM.
THAT’S IN A DIFFERENT PLACE THEY ARE PUTTING MEDICAL RECORD
INFORMATION AND WHAT THEY GET AND WHAT THEY SEE AND DON’T
SEE. ALL OF THE COMPLEXITY OF IT.
AND TO ACTUALLY GO OUT WITH AN OCCUPATIONAL THERAPIST TO SEE
PATIENTS AND HEAR THE PATIENTS SAY HOW CAN WE COME INTO THE
HOME AND DO THESE THINGS IS MEANINGFUL.
ALL THESE I DID IN MY NON TYPICAL ROLE OF BEING QUIET AND
LISTENING TO WHAT SOMEBODY SAID.
NOT JUSTIFYING, NOT EXPLAINING OR CORRECTING.
MY JOB WAS TO LISTEN AND HEAR AND TO BRING IT BACK.
AND THAT WAS THE MOST VALUABLE THING I THINK I COULD DO IN
THAT SETTING BECAUSE IT’S DIFFERENT FROM GOING ON A
SURVEY, GOING ON A SITE VISIT, ALL THOSE THINGS.
I HAVE ENCOURAGED MY STAFF TO PARTICIPATE, THEY ALL FOUND IT
SIMILARLY HELPFUL AND BENEFICIAL.
I HOPE TO CONTINUE TO DO MORE OF IT, BECAUSE IT REALLY
BROUGHT HOME TO ME THE PATIENT AT THE CENTER AND PART OF OUR
JOB IS JUST TO LISTEN AND HEAR WHAT YOU HAVE TO SAY ABOUT HOW
WE GET OUT OF THE WAY TO DELIVER CARE TO THE PATIENT IN
A SAFE, EFFECTIVE AND EFFICIENT WAY.
I WILL END AND TURN IT OVER TO DR. GREEN BECAUSE THE REST OF
THE DAY IS ABOUT LISTENING. [ APPLAUSE ]
>>I MENTIONED IT’S WONDERFUL TO HEAR THE IMPACT THE PATIENTS
OVER PAPERWORK IS MAKING TO DATE.
WE ALL KNOW THERE’S PLENTY MORE WORK TO DO.
WE NEVER GIVE UP AN OPPORTUNITY TO GET INPUT FROM OUR
STAKEHOLDERS. WE ARE GOING TO CONDUCT SOME
LISTENING SESSIONS OVER THE NEXT 40 MINUTES OR SO.
AND FOR THOSE PARTICIPATING IN THE LISTENING SESSIONS, IF YOU
LOOK AT THE AGENDA AT THE BOTTOM, THE ONES WE WILL HAVE
ARE CONDITIONS OF PARTICIPATION, RURAL HEALTH,
VALUE BASED ARRANGEMENTS, MEANINGFUL MEASURES PRIOR
AUTHORIZATION, INNOVATION AND PROGRAM INTEGRITY.
THOSE OF YOU WHO HAVE SIGNED UP TO BE IN THE RURAL HEALTH,
MEANINGFUL MEASURES AND INNOVATION SESSION, YOU ARE
GOING TO HEAD TO THAT BACK CORNER AND FOCUS ON OUR TEAM,
WE WILL ESCORT YOU TO WHERE THE SESSIONS WILL TAKE PLACE.
THE OTHER SESSIONS, THOSE WILL HAPPEN AT THE TABLES HERE.
WE WILL HAVE FACILITATORS AT EACH OF THE TABLES.
THEY WILL GIVE YOU AN IDEA OF THE KINDS OF INFORMATION WE ARE
LOOKING FOR IN THESE PARTICULAR BURDENED AREAS.
HOWEVER, IF THERE’S SOMETHING ELSE YOU WANT TO TALK ABOUT,
YOU KNOW WE ALWAYS WELCOME THAT.
YOUR JOB AS A TEAM AT THE TABLE IS TO BRAINSTORM AS MUCH AS YOU
CAN ON THE KINDS OF THINGS YOU WISH CMS WOULD WORK ON NEXT BUT
WHAT WE WOULD LIKE YOU TO WRITE DOWN SO WE CAN RECAP AT THE END
IS 2-3 TOP PRIORITY ISSUES WITHIN CONDITIONS OF
PARTICIPATION, OR RURAL HEALTH AND THE OTHERS, THAT YOU REALLY
WANT TO MAKE SURE CMS CONSIDERS FOCUSING ON.
ALL RIGHT? SO AT THIS POINT, LET ME JUST
CHECK WITH STEPHANIE. AT THIS POINT, WHY DON’T YOU GO
AHEAD AND HEAD BACK TO THE TABLES YOU ARE ASSIGNED TO.
REMEMBER THAT SEVERAL OF THEM ARE OUTSIDE OF THE AUDITORIUM.

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