CMS Aims to Reduce Physician EHR Burden, Provide More Data

Ken Terry

August 02, 2019

In the 2020 physician fee schedule proposal released earlier this week, the Centers for Medicare and Medicaid Services (CMS) focused on reducing the administrative burden on physicians, including work involving electronic health records (EHRs).

Simultaneously, the agency issued a proposal to reduce and streamline reporting requirements for clinicians who participate in the Merit-based Incentive Payment System (MIPS), and CMS separately announced a new pilot program to provide Medicare claims data to physicians at the point of care.

While making it easier in the new fee schedule proposal to justify evaluation and management (E/M) codes based on the complexity of medical decision-making or the time spent on delivering care, the physician fee schedule proposal "requires performance of history and exam only as medically appropriate," a CMS fact sheet said.

In addition, the fact sheet states, "We are proposing broad modifications to the documentation policy so that physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse-midwives could review and verify (sign and date), rather than re-documenting, notes made in the medical record by other physicians, residents, nurses, students, or other members of the medical team."  

"Clinicians are drowning in paperwork and reporting requirements caused by cumbersome government rules and regulations," said CMS Administrator Seema Verma in a news release. "These administrative costs add to the total cost of delivering healthcare, which means physicians often have to hire extra staff and spend more time complying with requirements instead of with their patients."

MVPs

CMS is also seeking to reduce physician burden in its proposed rule on the Quality Payment Program, which includes MIPS. In a new framework called the MIPS Value Pathways (MVPs), which would go into effect in 2021, CMS would reduce reporting requirements on clinicians, according to the news release.

"Under MVPs, clinicians would report on a smaller set of measures that are specialty-specific, outcome-based, and more closely aligned to Alternative Payment Models — new approaches to paying for care through Medicare that incentivize quality and value,” CMS states.

Under MVPs, CMS also envisions providing additional data and feedback to clinicians. "Having access to this information helps clinicians quickly identify strengths in performance as well as opportunities for continuous improvement in order to deliver the best outcomes possible for patients," CMS said in the release.

An agency fact sheet said that the MVP framework "would aim to align and connect measures and activities across the Quality, Cost, Promoting Interoperability, and Improvement Activities performance categories of MIPS for different specialties or conditions. A clinician or group would be in one MVP associated with their specialty or condition, reporting on the same measures and activities as other clinicians and groups in that MVP."

The MVP framework would also incorporate "claims-based quality measures that focus on population health/public health priorities." The combination of claims-based metrics with clinician reporting on a smaller number of focused measures "would streamline MIPS reporting, reduce complexity and burden, and improve measurement," CMS said.

The agency has issued a request for information to get feedback on MVPs from clinicians, patients, specialty societies, and other stakeholders.

Public comments on the proposed rules are due by September 27, 2019, CMS states.

App-based Access to Claims Data

CMS is also launching a pilot program, known as Data at the Point of Care (DPC), that will allow physicians to obtain claims data on their Medicare patients. Like the Blue Button 2.0 initiative, which lets patients download their records from CMS, DPC will use an application programming interface based on the Fast Healthcare Interoperability Resources (FHIR) standard, a Health Data Management article said.

This means that, in order to use the DPC app, physicians will need an FHIR-enabled EHR.

Physicians who participate in the program will be able to obtain data in their EHR workflow without logging into a separate application or going to a portal. According to CMS, the data will come from inpatient, outpatient, and pharmacy claims and will include diagnoses, procedures, preventive tests, and medications. This information will encompass outpatient visits to other doctors, hospital admissions, emergency department visits, and urgent care visits.

The first physicians in the program will test the app with fake data. By fall, participating providers will be given real data on their patients, according to MobiHealthNews.

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