Wed Jul 18, 2018, 10:49 AM


I got this letter today from Palmetto will be interesting to see what happens...Documentation requirements are a bear for providers, and EMR has not made it any easier. My docs are overwhelmed with paperwork....It's funny..I've been in this business for a LONG time, and every time the government has said that it was making it easier for providers, it ended up not being so...

Dear Doctor,

Thank you for the difference you make in your patients’ lives. Many of our nation’s best and brightest students go into medicine - the competition is intense for every spot. To become a practicing physician, you had to put in years of training, hours of studying, and long days and nights on the wards.

Your dedication and commitment have enabled you to join the profession that makes up the core of our health care system. But after years of education, training, and hard work, our system is not fully leveraging your expertise. Instead, doctors today spend far too much of their time on burdensome and often mindless administrative tasks.

From reporting on measures that demand that you follow complicated and redundant processes, to documenting lines of text that add no value to a patient’s medical record, to hunting down records and faxes from other physicians and sifting through them, wasteful tasks are draining energy and taking time away from patients. Our system has taken our most brilliant students and put them to work clicking through screens and copying and pasting. We have arrived at the point where today’s physicians are burning out, retiring early, or even second-guessing their decision to go into medicine.

In a recent Medscape survey of over 15,000 physicians, 42 percent reported burnout. Enough is enough. CMS’s focus is on putting patients first, and that means protecting the doctor-patient relationship. We believe that you should be able to focus on delivering care to patients, not sitting in front of at a computer screen.

Washington is to blame for many of the frustrations with the current system, as policies that have been put forth as solutions either have not worked or have moved us in the opposite direction. Electronic Health Records were supposed to make it easier for you to record notes, and the government spent $30 billion to encourage their uptake. But the inability to exchange records between systems - and the increasing requirements for information that must be documented - has turned this tool into a serious distraction from patient care.

CMS is committed to turning the tide. President Trump has made it clear that he wants all agencies to cut the red tape, and CMS is no exception. Last year, we launched our “Patients Over Paperwork” initiative, under which we have been working to reduce the burden of unnecessary rules and requirements. As part of this effort, we have proposed an overhaul of the Evaluation & Management (E&M) documentation and coding system to dramatically reduce the amount of time you have to spend inputting unnecessary information into your patients’ records. E&M visits make up 40 percent of all charges for Medicare physician payment, so changes to the documentation requirements for these codes would have wide-reaching impact.

The current system of codes includes 5 levels for office visits – level 1 is primarily used by nonphysician practitioners, while physicians and other practitioners use levels 2-5. The differences between levels 2-5 can be difficult to discern, as each level has unique documentation requirements that are time-consuming and confusing.

We’ve proposed to move from a system with separate documentation requirements for each of the 4 levels that physicians use to a system with just one set of requirements, and one payment level each for new and established patients. Most specialties would see changes in their overall Medicare payments in the range of 1-2 percent up or down from this policy, but we believe that any small negative payment adjustments would be outweighed by the significant reduction in documentation burden. If you add up the amount of time saved for clinicians across America in one year from our proposal, it would come to more than 500 years of additional time available for patient care.

In addition to streamlining documentation, under the leadership of the White House’s Office of American Innovation, we are advancing the MyHealthEData Initiative which promotes the interoperability of electronic medical records. Patients must have control of their medical information; and physicians need visibility into a patient’s complete medical record. Having all of a patient’s information available to inform clinical decision-making saves time, improves quality, and reduces unnecessary and duplicative tests and procedures. CMS is taking action to make this vision a reality, including recently proposing a redesign of the incentives in the Merit-Based Incentive Payment System or “MIPS” to focus on rewarding the sharing of health care data securely with patients and their providers.

We welcome your thoughts on our proposals, and we look forward to partnering with you to make them successful. Patients and their families put their trust in your hands, and you should be able to focus on keeping them healthy. And to secure the future strength of our system, we must make sure that the nation’s best students continue to choose to go into medicine.

We need your input to improve the health care system. Once again, thank you for your service to your patients.

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Arrow 7 replies Author Time Post
Reply Medicare (Original post)
Boadicea Jul 2018 OP
Meowmenow Jul 2018 #1
Boadicea Jul 2018 #2
Meowmenow Jul 2018 #3
Red Bull Jul 2018 #4
Boadicea Jul 2018 #5
Red Bull Jul 2018 #6
Mad Dog 20-20 Jul 2018 #7

Response to Boadicea (Original post)

Wed Jul 18, 2018, 11:05 AM

1. And when they ask or "welcome" your input...


So not only do you have to do all the work your job entails, but now you feel obligated to try and participate to help make the (useless) changes be somewhat effective. Of course the plan will sit on a shelf until the next revamp and nothing useful will be even looked at, much less implemented.

Been there done that, have the burnout! (not the medical field, but definitely with incompetent government "planning")

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Response to Meowmenow (Reply #1)

Wed Jul 18, 2018, 11:15 AM

2. My opinion:

We have been moving ever closer to socialized medicine. For decades. Right now, we are constrained from sharing things by HIPAA. This reads like they(the govt) wants to change that and have a centralized database, or at least, an option to make sharing records easier...I'm ok with that as a provider, but not sure of it as a patient...

As to the payments, moving to this kind of tiered payment will totally move medicine in the direction of socialized medicine. There are fee schedules now, and I don't think they will change much, but the documentation requirements will be the key.

Medical coding is formulaic and it is also subjective, so it will be interesting to see if they can produce a product that will make the coding and leveling of charges easier. I would welcome that.

Medicare may say they care for the patients first, but in my 20+ years of medical billing/auditing/coding, their first care is money.

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Response to Boadicea (Reply #2)

Wed Jul 18, 2018, 11:30 AM

3. The record sharing is tough.


A lot of the time as a patient I find the lack of it to be hugely frustrating (and even dangerous) but in terms of that info being centralized and "sharable" outside of actual medical providers...yeah makes me very uncomfortable.

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Response to Boadicea (Reply #2)

Wed Jul 18, 2018, 11:33 AM

4. Why not

Just stop accepting new Medicare patients?

My Doctor has not taken on a new patient period in 20 years except for the patients immediate family. He has a huge practice and most of all of us are fairly well off with great private insurance.

He has been my Dr since I was 15, he went to U of M at age 16, was in private practice at 31. So we have known each other for 35 years now and have a great relationship.

He stopped taking new patients as a way to cut Medicare as much possible out of his troubles and the only people that come in are kids grandkids and spouses of current patients.

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Response to Red Bull (Reply #4)

Wed Jul 18, 2018, 11:45 AM

5. My docs are nephrologists, so we can't.

Half our patient base is medicare/medicare advantage due to the ESRD component. Also, with the aging baby boomers, providers will see an increase in the the medicare base. I know a physician that does exactly what your provider does. He takes no new medicare patients, and he also does not do hospital rounds. Most family practices can do that, as they are not specialty providers. They limit their income, but they like the tradeoff as medicare patients are more work. As we are specialists, with a sicker demographic, we have to be providers with everybody:medicare, medicaid, BCBS, Aetna, UHC, Cigna, Tricare and the VA....

Your doc still has to meet the standard in documentation practices and is probably audited by the commercial insurance carriers in which he is a provider. All insurance companies audit all providers at one time or other to be in compliance with federal law.

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Response to Boadicea (Reply #5)

Wed Jul 18, 2018, 12:30 PM

6. Yes he does get audited

My Dr is very wealthy in is own right he does not do this for money but also makes a killing on his practice. He just despises red tape and dealing with Medicade or Medicare.

He was very smart on the way he did things. He is a great Dr and knows it. So when he hit a certian size on his practice he stopped taking new patients unless like me or my son you left for military service or are immediate family of the patient ie spouse, children or a dependant.

So for example I will down the road get Medicare but my son when he gets out of the army will add himself, wife and kids. So he is adding me to Medicare because my time came but is also adding on my son, daughter in law and Grandkids.

He is keeping his practice full to the gills by only taking family and also only has a few Medicare patient to deal with.

Wanted to add if i or any of his patients life imploded tomorrow and we ended up on Medicade or Medicare as our only insurance then that would be fine with him and we would still get the best Dr in the world and his great level of care.

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Response to Boadicea (Original post)

Wed Jul 18, 2018, 12:37 PM

7. Reads like a sales pitch. Be very careful.

Of course, something like this will cost something and they will want your support ($) to lobby it.

The OIA (Office of American Innovation) is a White House Organization and was formed a year and a half ago. Jared Kushner is in charge and it just now figuring out what it is suppose to do. It also appears that OIA is not FOIA friendly.

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