CMS Pledges To Roll Back Onerous Regulations

By Infinx
November 3, 2017

It’s no wonder that doctors can’t keep up with regulatory burdens and they regularly name it as a key contributor to physician burnout. It’s estimated that the Centers for Medicare & Medicaid Services (CMS) releases 11,000 pages of new regulations each year. The time and effort it takes to keep up with that tsunami of regulations is reaching a critical point. A study published in the Annals of Internal Medicine at the end of 2016 revealed that physicians are spending twice as much time on administrative work as they are with their patients—27 percent vs. 49 percent—and spend an additional 1 to 2 hours of personal time each night doing computer and clerical work.

On top of that, the American Hospital Association (AHA) just released a report saying that hospitals, health systems and other providers spend nearly $39 billion a year on administrative duties to comply with regulations. That equals $1,200 every time a patient is admitted to the hospital. “An average-sized community hospital (161 beds) spends nearly $7.6 million annually on administrative activities to support compliance with the reviewed federal regulations—that figure rises to $9 million for those hospitals with PAC beds,” the AHA report said.

2018 CMS program to reduce paperwork

Now CMS is launching a program to try to address that problem with the “Patient over Paperwork Initiative.” CMS officials will visit physician offices around the country to find out first-hand which CMS regulations are the most onerous to patient care and should be adjusted.

We’ve long held that physicians need to be freed of some unduly burdensome regulations in order to return to the business of caring for patients. Technology has helped to reduce some administrative tasks, namely billing, preauthorizations, revenue cycle management and the lynchpin of cash on hand—patient pay.  Physician associations and lobbying groups can’t find new pressure zones like MACRA (Medicare Access and CHIP Reauthorization Act of 2015) fast enough. The only way to survive the onslaught is to streamline practice functions with sharp back-end technologies that ensure that revenue is maximized at all levels.

Reducing the plethora of regulations with which physicians have to comply in their daily practice would help too. In announcing the Patient over Paperwork Initiative, CMS Administrator Seema Verma said she hears from many physicians across the United States about the burden of meaningful use requirements, which measures how providers are using EHR and tied to reimbursement, and that they consider quality measures tied to reimbursement to be onerous.

As she laid out the new CMS program, Verma said that she agrees that a smaller set of measures to track outcomes and quality is in order. News on exactly how CMS intends to reduce regulations is expected within a couple of weeks.

AHA recommendations make sense

When the AHA released its report, it posed a list of “General Opportunities to Reduce Burden.” Among the recommendations is a plea to reduce the regulatory burdens currently associated with billing and coverage verification requirements. The recommendation says, “Federal agencies should accelerate the transition to automation of administrative transactions, such as prior authorization.”

The AHA reasoning is that vast inconsistencies exist in the process. According to the report, “Many health plans do not use a common electronic transaction standard for prior authorization, requiring providers to instead utilize web portals, fax machines, email, and spend time on the phone to submit required information.”

Automated RCM technology improves revenue

We know this to be true. Our clients come to us to streamline and automate preauthorization and insurance verification to address inconsistencies. Meeting multiple, differing requirements per payor and adhering to differing standards within different windows of time soaks multiple FTE hours and can easily result in lost revenue. Automated, streamlined back-end revenue cycle management technology successfully addresses those complexities.

We applaud CMS for recognizing the undue pressure that physicians face in meeting onerous regulations. We hope it will result in meaningful change. It’s time for physicians to once again practice medicine, not paperwork. Just as important is the fact that patients need to once again be the focus of each physician’s daily practice.

About the Author



Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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