Dr. Gary LeRoy had to spend a significant part of a primary-care visit with one of his patients Tuesday hunting for information on his electronic health record about his recent hospitalization and medication use.
LeRoy was already over the 20 minutes allotted for the visit, and didn't have time to discuss whether the elderly man was up to date on immunizations.
"That's pretty typical, I fight with my EHR, and sometimes I win and sometimes it wins," said LeRoy, president-elect of the American Academy of Family Physicians, who practices at the East Dayton Health Clinic in Ohio.
LeRoy said he and his family medicine colleagues across the country are being "crushed by layer upon layer of administrative burden" from Medicare and other payers, as well as the lack of interoperability between different EHR systems.
The CMS says it is trying to remedy that. On Thursday, the agency issued a request for information seeking new ideas from the public on how to shift more of clinicians' time and system resources from bureaucratic busywork to patient care.
It is seeking ideas on issues including the streamlining of CMS reporting requirements; easing prior authorization procedures; enabling of better data sharing; improving quality reporting; addressing overly burdensome policies for rural providers; and simplifying rules for beneficiaries dually enrolled in Medicare and Medicaid.
Comments must be submitted within 60 days.
The new RFI is part of the CMS' Patients over Paperwork initiative launched in 2017, which the agency claims has significantly cut red tape, saving an estimated 40 million hours and $5.7 billion through 2021.
The agency cited a number of changes it already has made, including simplifying patient assessments for skilled nursing patients and eliminating 79 overly burdensome or redundant quality measures.
The CMS also is finalizing a number of documentation, coding and payment changes it says will reduce administrative burden and improve payment accurate for outpatient evaluation and management visits. That includes paying a single rate for several levels of E/M visits.
The CMS said through the RFI process and listening sessions, it has received more than 3,000 comments on reducing administrative burdens and has compiled 1,146 "burden topics." Of those topics, it says it has resolved or is addressing 80% of them through regulatory changes or outreach to providers and beneficiaries.
"Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated or duplicative requirements that drain clinicians' time but contribute little to quality of care or patient health," CMS Administrator Seema Verma said in a written statement.
LeRoy gives the CMS credit for its Patients over Paperwork campaign, but says family physicians aren't seeing significant relief. Part of the problem is that the CMS' shift to value-based payment models, including the Merit-based Incentive Payment System, has created complex new requirements.
Another problem is that physicians have to deal with different policies and requirements from Medicare, Medicaid and the multitude of other public and private insurers.
But the top issue by far is the user-unfriendliness and lack of interoperability of electronic health records, American Academy of Family Physician member surveys show.
Physicians desperately want standardization of EHRs so they speak the same language, as well as uniform performance requirements for all physicians, payers and patients across the country, LeRoy said.
"CMS is at least acknowledging the problem of administrative burden," he said. "But the house is on fire, and just hearing the rescuers' sirens is no consolation."
