October 14, 2016

NEWS ALERT: CMS Unveils Initiative to Help Physicians in Their Dealings with Medicare

By


Andy Slavitt

EDITOR’S NOTE: Listen to Monitor Mondays on Oct. 17, 10 a.m. ET for more information on this developing story.

The Centers for Medicare & Medicaid Services (CMS) today announced a new initiative it claims will “improve the clinician experience with the Medicare program,” the agency announced via a press release.

“As we implement delivery system reforms from the (Patient Protection and) Affordable Care Act and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), this new long-term effort aims to reshape the physician experience by reviewing regulations and policies to minimize administrative tasks and seek other input to improve clinician satisfaction,” the release read. The initiative will be led by senior physicians within CMS who will report to the Office of the Administrator.

“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 on the demands on the physician and clinician workforce,” said Andy Slavitt, acting Administrator of CMS. “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.”

CMS noted that Slavitt is appointing Dr. Shantanu Agrawal to lead the project, which will cover documentation requirements and existing physician interactions with CMS, among other aspects of provider experiences. To ensure that CMS is hearing from physicians in the trenches of modern healthcare, each of the 10 CMS regional offices will oversee local meetings to take input from physician practices within the next six months and regular meetings thereafter, the agency added.

These local meetings are expected to result in a report with targeted recommendations to the CMS Administrator in 2017. Three of CMS’s regional Chief Medical Officers – Dr. Barbara Connors in Philadelphia, Dr. Ashby Wolfe in San Francisco, and Dr. Richard Wild in Atlanta – have agreed to serve as regional champions of this initiative, the agency said.

“CMS is turning a new page in assessing not only how to reward for quality, but also to reduce administrative hurdles,” Agrawal said. “I look forward to hearing about what steps we can take to make the practice of medicine in Medicare more efficient and rewarding.”

The initiative will begin with an 18-month pilot program intended to reduce medical review for certain physicians while continuing to protect program integrity, CMS explained. Under the program, providers practicing within specified Advanced Alternative Payment Models (AAPMs) are to be relieved of some scrutiny under certain medical review programs (advanced APMs were identified as a potential opportunity for the pilot because participating clinicians share financial risk with the Medicare program).

CMS noted that two-sided risk models provide “powerful motivation” to deliver care in the most efficient manner possible, greatly reducing the risk of improper billing of services. After the results of the pilot are analyzed, the agency will consider expansion along various dimensions, including additional advanced APMs, specialties, and provider types.

“Like all successful changes, we will begin with the basic steps and build over time,” Wolfe said. “Most importantly, we are excited to build on the listening and engagement process we began this year by creating more opportunities for physicians to interact with CMS, especially through our regional offices.”

Clinicians participating in Medicare serve more than 55 million of the country’s seniors and individuals with disabilities, according to CMS.

“Through this new initiative, CMS is focused on supporting and empowering those clinicians through a flexible, modern Medicare program informed by clinician expertise and experience,” the agency concluded.

For more information about the new initiative, go online to https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-13.html.

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Mark Spivey is a national correspondent for RACmonitor.

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Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years. 

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