Background: CMS launches initiative to reduce administrative burdens
The request is part of the agency's "Patients over Paperwork" initiative, which focuses on reducing regulatory burdens on providers in an effort to improve patient care. CMS in 2017 issued an initial RFI seeking feedback on how the agency could reduce administrative burdens. CMS on Thursday said it "has addressed or is in the process of addressing 83% of the actionable areas of burden identified through the 2017 RFI."
For example, CMS said it:
- Allows a beneficiary's initial prescription for a immunosuppressive to be shipped to an address other than the beneficiary's home to ensure the beneficiary has timely access to their treatment when they do not return home immediately after discharge;
- Introduced regulatory changes to the home recertification and eliminated the requirement for a physician to include a separate statement on the length of time a patient will need home health services;
- Launched the Patient Driven Payment Model, which is a mixed classification system that ties Medicare payments to skilled nursing facilities to patients' conditions rather than the quantity of services they receive; and
- Launched the Meaningful Measures initiative, which has eliminated 79 low-value quality measures and reduced reporting requirements.
CMS estimates that regulatory reforms made under the initiative as of January will save the health care system an estimated 40 million hours and $5.7 billion from 2019 through 2021. CMS said the projected savings are based on both proposed and final rules.
CMS Administrator Seema Verma in a release said, "Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians' time but contribute little to quality of care or patient health."
CMS requests new recommendations to further reduce administrative burdens
CMS in the new RFI is asking providers, patients, and their families to recommend additional changes CMS can make to "rules, policies, and procedures that would shift more of clinicians' time and our health care system's resources from needless paperwork to high-quality care that improves patient health," the agency said.
Specifically, CMS is seeking suggestions on how the agency can reduce burdens related to:
- Beneficiary enrollment and eligibility determination;
- Coding and documentation requirements for Medicare and Medicaid payments;
- Policies and requirements for beneficiaries who are dually enrolled in Medicaid and Medicare;
- Prior authorization procedures;
- Reporting and documentation requirements; and
- The agency's process for issuing regulations and policies.
Verma said, "Patients over Paperwork remains a top priority and a driving force in lowering health care costs," and CMS is "doubling down on efforts to decrease health care costs by reducing administrative burden."
CMS is accepting public comments on the new RFI until Aug. 12 (Meyers, Modern Healthcare, 6/6; Morse, Healthcare Finance News, 6/7; Stein, Inside Health Policy, 6/6 [subscription required]; CMS release, 6/6).
Next, get ideas for working with clinicians to reduce the PA burden
Over the past decade, prior authorization requirements have been continuously increasing, creating non-value-added administrative work for providers and payers and often resulting in needless delays in patient care.
To learn more ways to improve the PA process, download our research report. You’ll learn best practices for staffing, process redesign, improving information flow, and working with payers to reduce PA requirements.