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Remarks by Administrator Seema Verma at the Patients Over Paperwork Anniversary Event: “Patients Over Paperwork: A Journey Forward”

Remarks by Administrator Seema Verma at the Patients Over Paperwork Anniversary Event: “Patients Over Paperwork: A Journey Forward”
(As prepared for delivery – October 29, 2019)

Hello and thank you for joining us today as we mark the two year anniversary of one of our signature initiatives: Patients over Paperwork.

I want to pause here at the beginning to thank Congressman Larry Bucshon and Congressman Michael Burgess in particular for their attendance today. As doctors and as leaders on the Health Subcommittee of the House Energy and Commerce Committee, they are key players in the effort to deliver a healthcare system that works for patients. Their contributions have been invaluable. They will be delivering a few words in a moment, and I look forward to hearing their perspectives.

Launched in 2017, Patients over Paperwork is the central plank of CMS’ ongoing contribution to President Trump’s executive order to “Cut the Red Tape.” Since that time – and in conjunction with President Trump’s recent executive order on Medicare – we have searched high and low for duplicative, unnecessary or excessively costly requirements. This effort was driven by the conviction that reams of prescriptive government regulations that dictate processes for the health system have failed. Regulations should identify expected outcomes, results and standards – not micro-manage everything the health industry does.

Patients belong at the center of the healthcare system. For too long, they have been shunted aside, as mountains of paperwork distracted their clinicians and increased their bills. A recent study showed that the largest source of waste in the American healthcare system -- $266 billion – can be attributed to administrative costs. So we launched this initiative to right the ship: by getting rid of outdated regulations that don’t make sense, we have eased provider burden, reduced administrative costs, and put patients first.

The process began with a wide-ranging Request for Information that yielded over 3,000 discrete data points related to over 1,100 different issues. To-date, we have acted on, or are considering, over 80% of the items mentioned, with the remainder falling outside of CMS’ purview. In August 2019, we received over 560 submissions to a separate RFI, which we are currently analyzing.

In addition, we have gone out to the front lines to understand the impact of our rules. The Patients over Paperwork Initiative has pushed the CMS team to take a new approach to rulemaking – they’re getting out of the office and seeing how their work truly affects providers, clinicians, staff, beneficiaries, and families. By genuinely listening to the concerns of stakeholders, government can facilitate innovation, rather than stymie it. This boots-on-the-ground approach has allowed us to conduct 800 individual interviews, 185 interviews with subject matter experts, and 102 listening sessions across the nation.

While there’s much more to be done, we have made considerable inroads. Before previewing what’s to come in the future, I’d like to give you a brief tour of some of the highlights of work that's been done.

Just in the last month, we released the Omnibus Burden Reduction final rule and a proposed modernization of our regulations implementing the Stark Law. The Omnibus rule affected providers across the healthcare landscape. It removed Medicare regulations that stood like a brick wall between patients and their doctors, yet did nothing to advance patient health and safety. By itself, it will save $800 million dollars and 4.4 million burden hours.  In our listening sessions, Stark consistently ranked among the top concerns of providers and clinicians. Our proposed rule responds to these concerns. It eases the regulatory burden on value-based arrangements and provides badly needed new guidance to help providers minimize compliance burden under the Stark Law.

We’ve also released a proposed rule that applies to nursing homes. I remember visiting a nursing home a couple years ago, so I know how badly it was needed. The staff brought me massive binder after massive binder, full of printouts of the litany of outdated rules that that seemed to dictate their every decision. Our proposed rule intends to cut through that morass. The rule would save $616 million – money that could be reinvested into patient care.

While physician burnout remains high, we are turning our attention to that issue.  Last year, we made historic proposals to simplify how doctors document evaluation and management codes used to bill Medicare. These codes had been in place for over 20 years. We are continuing that work this year. Additionally, to make it easier for teaching physicians to train the next generation of doctors, we increased flexibility for medical students. We have proposals to extend this policy to other clinical teachers like physician assistants and nurse practitioners.

I also want to highlight our “Meaningful Measures” initiative. It involves focusing on quality rather than process. That means cutting accumulated process requirements that don’t prioritize patients. Our efforts have eliminated 79 measures for a projected savings of $128 million and 3.3 million burden hours through 2020. And we’re not done. We’ve proposed to completely revamp MIPS. That process allows us to create measures in partnership with medical professional societies.

We’ve placed an unprecedented priority strengthening the rural healthcare system. Under our Rural Health Strategy, we are applying a rural lens to the vision and work of CMS, investigating ways to alleviate burden for rural hospitals. For example, our proposal to reduce levels of physician supervision for certain hospital services, makes it easier for rural hospitals to provide access to these services. We look forward to hearing from you today on how we can go further.

And it’s important to note that we are taking care that our efforts to cut back on needless regulatory requirements also promote the integrity of our programs. Our efforts have reduced provider burden and appeals to an all-time low, but there is more to be done. And so CMS is working with the DaVinci Project, a private sector initiative led focused on integrating value-based data exchange to help streamline access to coverage requirements.

All told, our burden reduction efforts have saved $6.6 billion and 42 million burden hours through 2021. It’s no secret that healthcare costs have been rising for decades. By 2026, one in every five dollars in our economy will be spent on healthcare. In other words, these savings could not have come at a better time. I want to thank all of the stakeholders who provided such invaluable input, particularly clinicians who are on the front lines day in and day out.

Before closing, I want to also say that while I have focused on regulatory changes today, there have been many important updates at the sub-regulatory level as well. Patients over Paperwork informs everything we do.

As healthcare providers and clinicians, you’re the experts. You underwent extensive schooling and entered this profession to cure illnesses and save lives – not to get bogged down in a never-ending morass of paperwork. But as every doctor and nurse knows, time that should be spent with patients is too often spent with a pen or computer mouse in hand, poring over confusing and duplicative forms. We are proud to have reduced that burden and given you more time with your patients.

And we’re is determined to keep the ball rolling. That’s why we’ve gathered you all here today. We’ve crafted today’s listening sessions to align to our 16 strategic initiatives, which were informed by our first rounds of discussions with you. We delivered on the concerns you voiced then, and we’re eager to do the same for what you tell us today. We are particularly interested in your thoughts on relaxing overly burdensome Conditions of Participation, addressing Rural health issues, and tackling prior authorization. That last one – prior authorization – is particularly important to us. And more broadly, we’re determined to expand dramatically our burden reduction efforts across not just traditional Medicare, but all our programs. It’s safe to say that you will be hearing from CMS on these issues in the future. Your perspectives during our breakout sessions today will shape our approach.  

Before getting that process started, I want to turn over the microphone to our first guest, Congressman Burgess for a few words. Thank you.                                                

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