Patients Over Paperwork is Real

CMS is advancing an initiative they call ‘Patients Over Paperwork”. We are all busy people and don’t always pay close attention to slogans and platitudes coming from the government.  But as the proportion of our revenues from public coffers has increased, it’s important to be focused on the broader themes that shape public policy.

This particular campaign is primarily about ‘cutting red tape’ and reducing administrative burdens. Getting rid of excessive regulation, like the way HIPAA was supposed to streamline claims and health data.  Al Gore’s Reinventing Government was supposed to dump regulations.  The HITECH act was going to automate medical records.  Is this more of the same?

It is not. What’s different is a particular focus on improving the beneficiary experience and maximizing the time patients and providers spend together.  Last week we have four significant regulations published that advance the initiative.  They point the way to what is to come in the latter half of this administration.

Consider the 2020 Medicare Advantage proposed rule. Telehealth will be a basic benefit regardless of the site of service.  So plan members can have house calls on their phone.  In the comfort of their home.  It doesn’t get any more convenient that that for members. Another provision makes it easier for members to make appeals, something very few take advantage of today.  And Stars continues to increase the member experience as a contribution to the overall score.

In the final rule for Home Health changes were made in the payment model so that the reimbursement is more closely tied to patient needs and outcomes than on the particular services that are provided. To encourage innovation and convenience, investments in remote patient monitoring will be allowable costs for HHA’s.  Sharing live-time data can provide timely interventions and faster recovery for patients.  There are also changes to encourage more home infusion services.  Anyone who has helped a friend or loved one through a cancer episode knows that spending hours in an infusion therapy center is a burden.

The 2019 Physician Fee Schedule final regulation simplifies the documentation for office visits so that the doctor spends more time talking to the patient rather than pecking on a computer.   It also makes payment available for reviewing data submitted by the patient electronically like a video or photo, or monitoring data like blood pressure or weight.   There is also expanded coverage for telehealth services to treat opioid addiction.   Rounding out this bundle of new rules, the final Outpatient PPS rule for 2019 expands the services that are available in Ambulatory Surgery Centers, which are less expensive and often more convenient for patients.

We have a president who wants to put America first. And we have a CMS that wants to put patients first.  That is opening up a lot of opportunity for our industry.

 

 

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David Sayen
David Sayen

David Sayen is Senior Vice President of Client Relations at Gorman Health Group (GHG). In this role, David guides GHG clients in developing strategies to respond to rapidly changing federal program opportunities. David recently joined GHG after a distinguished career at the Centers for Medicare & Medicaid Services (CMS), most recently as the Administrator of the San Francisco Regional Office.

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