CMS Aims to Reduce Physician Burden While Improving Quality

Keith L. Martin

February 25, 2020

BALTIMORE — With clinician burnout still high, partly because of complicated quality measure reporting, the federal government says it has an improved plan to help physicians focus more on patient care and less on process.

To help alleviate these problems, the Centers for Medicare & Medicaid Services (CMS) unveiled a new strategy for standards of care for 2020 and beyond at its annual Quality Conference in Baltimore, Maryland.

Seema Verma

CMS Administrator Seema Verma told Medscape Medical News that the agency's new plans, as well as ones that have been put in place during her 3-year tenure, aim to reduce physician fatigue and frustration.

"I think a lot of our work, nearly 100% of it, has been focused on addressing the issue of burden [and burnout]," Verma said.

In the latest Medscape National Physician Burnout & Suicide Report, 42% of physicians said they are burned out on the job. The top two factors contributing to this, according to physicians, are the number of bureaucratic tasks, including paperwork, and the increasing computerization of medicine through electronic health records (EHRs).

The new quality strategy that Verma unveiled is based on four main pillars:

  • establishing clear and reasonable expectations for quality through standards and quality measures;

  • strengthening the agency's oversight and enforcement of those standards to ensure accountability;

  • promoting transparency, competition, and consumer choice by providing the public with information to make better care decisions; and

  • modernizing quality improvement efforts through technological and data advances.

In addressing the first issue, establishing clearer and more reasonable quality standards and measures, Verma pointed to CMS' Patients Over Paperwork initiative, which streamlines agency regulations and reduces process rules. These measures include evaluation and management (E/M) code reforms and simplifying office documentation.

This effort alone, Verma noted, will save the country $6.6 billion and 42 million burden hours for physicians and other healthcare providers through the end of next year.

"This is time and resources that can instead be devoted to delivering high-quality care to patients," she said.

Making Quality Measures More Meaningful

Verma told Medscape Medical News that in creating Patients Over Paperwork, she and other CMS officials held listening tours with physicians who were struggling with the agency's Quality Payment Program, including its Merit-based Incentive Payment System (MIPS) for reporting quality data tied to patient care.

"They were telling us [collecting/reporting] the data was taking them numerous hours and they didn't really understand how to do it and that it was confusing," she said.

To remedy that problem, CMS is rolling out its MIPS Value Pathways (MVP) program, beginning in 2021, as part of its Meaningful Measures initiative. MVP moves away from general quality measures and toward measures that are more relevant to the physician's scope of practice.

To ensure that they are aligning specialties and quality measures, CMS is working with specialist societies to develop measure sets that are "more important to physicians," said Verma. "This should make the process easier in terms of selecting measures and reporting on them."

Technology's Role in Reducing Burden

In describing the formal launch of Meaningful Measures 2.0 in the coming months, Verma said the ultimate vision is for physicians to be able to report quality measures "without lifting a finger" and that data will be seamlessly transmitted from physicians' EHRs.

"It's difficult for physicians to have to go through tons of medical records — even if they are electronic — to report quality measures," Verma told Medscape. "By having it electronically, they may not have to do anything at all. We [at CMS] may be able to look at claims data or registry data, for example, quality calculations without them having to take an active role. We are pretty squarely focused on reducing their burden."

Verma noted that much of this technological progress will be made through the Fast Healthcare Interoperability Resources (FHIR) software standard. This will allow clinicians to share patient data regardless of the EHR system they use. Recently, the Office of the National Coordinator of Health IT unveiled its own strategic report for reducing physician burden through technology that utilizes FHIR.

Use of the standard, Verma noted, will "pave the way for stakeholders to submit data to a centralized submission system" to better collect and measure quality data.

So far, she noted, the Meaningful Measures framework has eliminated 18% of unnecessary or tapped out measures and that it is projected to save $128 million and 3.3 million burden hours by year's end.

"[CMS is] setting and enforcing standards for quality that are focused on outcomes, rather than processes — and after that, leaving quality in the hands of consumers and providers to work out between themselves," said Verma.

Keith L. Martin is editorial director for Medscape Business of Medicine.

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