Does CMS?s ?Other? Announcement Signal a More Physician-Friendly Strategy?

Thursday, October 20, 2016 | Larry Sobal

I get it that all the media attention is focused on the long-awaited MACRA final rule. However, at 2,398 pages, it’s moving into the same territory as the 2,700-page Affordable Care Act. That means it could take weeks to decipher. So, unlike everyone else, I’m not blogging this week about MACRA (a topic with around 90,000 results on Google already). Instead, I thought I would cover another announcement CMS made last week that is flying somewhat under the radar. 

The announcement was about a new initiative designed to improve the clinician experience with the Medicare program; it “aims to reshape the physician experience by reviewing regulations and policies to minimize administrative tasks and seek other input to improve clinician satisfaction.”  

CMS Acting Administrator Andy Slavitt says, “Physicians and their care teams are the most vital resource a patient has. As we implement the Quality Payment Program under MACRA, we cannot do it without making a sustained, long-term commitment to take a holistic view of the demands on the physician and clinician workforce. . . . The new initiative will launch a nationwide effort to work with the clinician community to improve Medicare regulations, policies, and interaction points to address issues and to help get physicians back to the most important thing they do—taking care of patients.”

Before I go any further, let’s stop for a minute and contemplate the insinuation behind those statements. Does this imply that physicians are going to see a kinder, gentler and more physician-centric CMS in the future? That would indeed be revolutionary and transformational. 

Here’s what was announced. Under an 18-month pilot, physicians practicing within certain Advanced Alternative Payment Models (APMs) will be relieved of additional documentation scrutiny under Medicare medical review programs. As part of the effort, the agency will direct Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) to consider doctors participating in Advanced APMs as a low-priority for post-payment claim reviews.

The pilot will have two phases, beginning in early 2017, and will include Advanced APMs, Next Generation Accountable Care Organizations, Medicare Shared Savings Program Track 2 and Track 3 participants, Pioneer Accountable Care Organizations, and Oncology Care Model two-sided track participants.

On the surface, this sounds like an attempt to reduce what has become an almost unbearable wave of administrative and legislative burdens that have been thrust upon physicians by CMS over the past few years.

Andy Slavitt has appointed Shantanu Agrawal, M.D., to lead the development and implementation of the initiative, including documentation requirements and existing physician interactions with CMS, as well as other aspects of provider experiences. In addition, in order to ensure that physicians have a dominant voice, each of the 10 CMS regional offices will oversee local meetings to gather input from physician practices over the next six months, with regular meetings thereafter. Those meetings will then inform a report with specific recommendations to the CMS administrator in 2017. 

On the surface, this sounds like an attempt to reduce what has become an almost unbearable wave of administrative and legislative burdens that have been thrust upon physicians by CMS over the past few years. The frustration and burnout that physicians increasingly feel have roots in CMS-induced legislation that distract and redirect doctors away from direct patient interaction. This was evidenced in the 2015 Great American Physician Survey, which listed too much third-party interference (39.9%) as the biggest frustration with being a physician. In the 2016 Physicians Foundation Survey, 58.3% of respondents listed regulatory/paperwork burdens as the least satisfying aspect of medical practice.

Let’s keep in mind that the mission of the Recovery Audit Program is to identify and correct Medicare and Medicaid payments through the detection and collection of overpayments made on claims for health care services provided to Medicare and Medicaid beneficiaries. It returned $1.6 billion in payments to CMS in its most recent reported year—and I suspect nobody at CMS is interested in reducing the ability to collect on alleged overpayments that don’t have adequate documentation to support the billed claim.

Here’s the spoiler alert: for the vast majority of physicians, this pilot will not affect the current medical review process being conducted by RACs and MACs. The medical review reduction pilot will only affect claims paid to hospitals and physicians aligned with certain Advanced APMs, which today is a very small number.

The intentions may be honorable, but I’m not ready to proclaim last week’s announcement as anything other than a small experiment that will not have a positive impact on more than just a small percentage of physicians. That’s too bad. For a second, I thought CMS was announcing some sweeping change that would cause physicians to take notice and feel like CMS is really trying to make their lives easier. 

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

 

 

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