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Fleming aims to reduce red tape

Two top federal health officials are talking about cutting the regulatory red tape for how physicians are reimbursed, as the final MACRA rule on the physician fee schedule is due out this week.

The Centers for Medicare and Medicaid Services has taken a hard look at MACRA and is reexamining the process for conducting quality measurement across the board, CMS Administrator Seema Verma said at the Health Care Payment Learning and Action Network Fall Summit Oct. 30.

“2017 has been a transitional year for MACRA,” Verma said. “We appreciate all of your thoughts and comments on the Year Two Proposed Rule, as we work to make this program less of a burden.

Related to our efforts to minimize burden in the implementation of MACRA, we’re reexamining our process for conducting quality measurement across the board.”

There are too many measures, Verma said, and they are measuring process, not outcomes.

“That’s why we’re revising current quality measures across all programs to ensure that measure sets are streamlined, outcomes-based, and meaningful to doctors and patients.”

Verma did not specially refer to revisions to MACRA for the physician fee schedule rule expected this week. In fact she gave as examples a review of the hospital star rating program and the new initiative, Meaningful Measures, a streamlined approach for hospital and physician reporting focused on outcomes.

The Office of the National Coordinator for Health Information Technology is working with CMS on a new concept for physician reimbursement that would reduce regulations, said John Fleming, MD, deputy assistant secretary for Health Technology Reform.

Politico reported that Fleming in a recent speech talked about partially reimbursing physicians based on a “weighted average” of past services. This would base payments for the physicians’ “evaluation and management services” — a common reimbursement code — based on the past average, reducing the need for documentation to hit reimbursement benchmarks.

Fleming clarified that any discussion is merely a concept at this point, and is not part of a decision-making model or MACRA.

“I was addressing a more fundamental part of physician burden under the 21st Century Cures Act to address administrative burden,” Fleming said Wednesday.

For instance, EHRs are seen as a big pain point for providers, he said, but the documentation and administrative work are behind the problem.

“If we come out with a better technology, that won’t solve the problem,” Fleming said.

Verma said patient outcomes should be the focus, and there’s no indication that required reporting measures actually improve health outcomes.

Inpatient hospitals report up to 61 quality measures, she said. Of these, 12 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, she said.

The American Hospital Association recently published a report showing that health systems, hospitals, and post-acute care providers must comply with 629 mandatory regulatory requirements, Verma said. Providers spend nearly $39 billion a year solely on the administrative activities and the average-sized hospital dedicates 59 full-time employees to regulatory compliance.

Last week, CMS announced “Patients Over Paperwork,” an initiative to go through all of its regulations to reduce burden, according to Verma.

“A case in point is the implementation of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA as you know it,” Verma said. “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.”

But there are few Advanced APM models available and hardly any for specialists, Verma said.

“We are hearing that doctors are overwhelmed by MACRA’s new requirements and confused about the steps that they need to take,” she said.

Most physicians are looking at entering the MIPS program, rather than APMs for payment. Performance on 2017 quality scores in the Merit-based Incentive Payment System will be used to determine 2019 payments.

Physicians not participating in MIPS, or APMs, will see their compensation frozen over the next few years, according to Tim Gronniger, senior vice president of Development and Strategy for Caravan Health, who is a former deputy chief of staff at the CMS.