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CMS Medicare Proposal to Boost Patient-Provider Relationships

The proposed changes streamline requirements for the Quality Payment Program and the Physician Fee Scheduling, ideally reducing administrative burden and allowing for meaningful patient-provider relationships.

patient-provder relationship

By Sara Heath

- CMS has proposed changes to the Quality Payment Program and Medicare Physician Fee Schedule that aim to reduce administrative burden, improve patient-provider relationships, and drive overall better healthcare quality at a lower cost.

Specifically, the proposed changes to the Quality Payment Program would remove “low-value” quality measures and enhance the Promoting Interoperability initiative that was announced earlier this year.

Changes to the Physician Fee Schedule would include streamlining and offering flexibility in documentation requirements for Evaluation and Management office visits. Currently, these visits constitute about 20 percent of allowed charges under the Physician Fee Schedule and thus take up a significant portion of providers’ time.

Additionally, proposals could reduce physician supervision for radiologist assistants during diagnostic tests. The changes would also remove functional status reporting requirements for outpatient therapy, which CMS says can be “burdensome and overly complex.”

These proposed changes should significantly reduce clinician reporting burden, CMS reported. If passed, individual clinicians with patient panels with 40 percent or more of Medicare beneficiaries will see nearly 51 hours less of administrative work. For providers across the nation, this could result in 29,305 hours of time saved and approximately $2.6 million in reduced administrative costs in 2019.

Ideally, reduced administrative burden should allow providers to spend more time with their patients, driving patient satisfaction and better patient-provider relationships, according to CMS Administrator Seema Verma.

“Today’s proposals deliver on the pledge to put patients over paperwork by enabling doctors to spend more time with their patients,” Verma said in a statement.

“Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care,” she continued. “This Administration has listened and is taking action. The proposed changes to the Physician Fee Schedule and Quality Payment Program address those problems head-on, by streamlining documentation requirements to focus on patient care and by modernizing payment policies so seniors and others covered by Medicare can take advantage of the latest technologies to get the quality care they need.”

In addition to the proposed reporting requirement changes, CMS has also proposed changes to the Physician Fee Schedule that should enhance virtual health utilization.

“CMS is committed to modernizing the Medicare program by leveraging technologies, such as audio/video applications or patient-facing health portals, that will help beneficiaries access high-quality services in a convenient manner,” said Administrator Verma.

Specifically, these changes would pay physicians for virtual check-ins with patients, pay clinicians for review of patient-submitted photos, and expand Medicare-covered telehealth use to include prolonged preventive services.

These changes come as a part of CMS efforts to improve healthcare quality while cutting healthcare costs, according to HHS Secretary Alex Azar.

“Today’s reforms proposed by CMS bring us one step closer to a modern healthcare system that delivers better care for Americans at a lower cost,” Azar said in a statement. “Such a system requires empowering American patients by giving them price and quality transparency and control over their own interoperable health records, goals supported by CMS’s proposals.”

In addition to putting patients in control of their own care, these changes should help patients build healthcare partnerships with providers who could no longer face reportedly burdensome reporting requirements, Azar said.

“These proposals will also advance the successful Medicare Advantage program and accomplish a historic regulatory rollback to help physicians put patients over paperwork,” Azar explained. “Further, today’s proposed reforms to how CMS pays for medicine demonstrate the commitment of HHS to implementing President Trump’s blueprint for lowering drug prices. The ambitious reforms proposed by CMS under Administrator Verma will help deliver on two HHS priorities: creating a value-based healthcare system for the 21st century and making prescription drugs more affordable.” 

The announcement also included information about reducing prescription drug costs, a significant priority for CMS as of late. Effective January 2019, the Administrative is implementing changes to Medicare Part B that would make drug costs more closely match the actual cost of the drug, which will ideally reduce out-of-pocket patient costs, the agency said.

Furthermore, the announcement included a request for information (RFI) as it relates to price transparency. The RFI seeks to determine whether providers and suppliers should be required to inform patients about charge and payment information for patient financial responsibility. The RFI will also ask respondents which data elements will be most useful to promote price shopping and patient empowerment in healthcare.


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