Patients over Paperwork – CMS’s Approach to improve Patient Care

On 26th Sept 2019, the Centers for Medicare & Medicaid Services (CMS) is taking action at President Trump’s direction to “cut the red tape,” bringing relief to America’s healthcare providers by reducing unnecessary burden, allowing them to focus on their top priority – patients. The Omnibus Burden Reduction (Conditions of Participation) Final Rule strengthens patient safety by removing unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers. This rule advances CMS’s Patients over Paperwork initiative by saving providers an estimated 4.4 million hours previously spent on paperwork annually, with overall total provider savings projected to be approximately $8 billion over the next 10 years, giving doctors more time to spend with their patients.

CMS is focused on making sure patients get safe, high-quality care, and time with their healthcare providers. As such, CMS conducted a comprehensive review of regulations to determine where changes to obsolete, duplicative, or unnecessary requirements could be made to improve healthcare delivery. The agency is finalizing changes that streamline and improve regulations to provide a greater focus on patient safety and improve the quality of care. CMS performed this work from three perspectives: improving patient care, eliminating burdensome rules, and eliminating duplicative regulations.

Under existing regulations, each Medicare-certified hospital is required to develop and maintain ongoing Quality Assessment and Performance Improvement (QAPI) programs and infection control programs. The final rule will streamline the regulations to allow multiple hospitals within a system to employ a unified QAPI program. This change makes it easier for hospitals to implement best practices and innovations among facilities resulting in quicker improvements in quality of care. This also benefits small and rural hospitals by allowing them to draw from the resources and clinical expertise of a larger hospital system.

The final rule also focuses on eliminating burdensome rules by reducing certain required activities. For example, under previous rules, orders for X-rays were required to be written and signed. Under the new regulation, such orders may be transmitted in written form, by telephone, or electronically. Additionally, by revising timelines for some requirements, providers will now have more time to spend on direct patient care. Specifically, CMS is reducing the frequency of policy reviews and program evaluations that rural health clinics and federally qualified health centers are required to conduct from annually to once every two years.

What are the Patients over Paperwork Initiative?

In October 2017, CMS and the Trump administration announced Patients Over Paperwork, their initiative to decrease the unnecessary burden on Medicare and Medicaid healthcare providers. By reducing administrative burdens, CMS seeks to make healthcare more efficient and patient-centric. This initiative responds to the healthcare community’s complaints regarding excessive federal regulation.

The problem’s extent is clear when considering that CMS averages 58 rules published annually, with nearly 11,000 pages of new regulatory text each year. Furthermore, a recent study in Annals of Internal Medicine reported that primary care physicians spend 27 percent of their time on clinical services and 49 percent of their time on administration. CMS hopes cutting red tape will reduce the time providers must spend doing paperwork so there is more time to treat patients, thus improving care.

CMS thinks that this Omnibus final rule will help to achieve approximately $800 million in savings annually through the year 2028, or approximately $8 billion over the next 10 years. For purposes of tracking savings under Executive Order 13771, “Reducing Regulation and Controlling Regulatory Costs,” the savings number is calculated in 2016 dollars and discounted at 7 percent relative to 2016 to ensure ease of comparison across all regulatory activities pursuant to the Executive Order. This alternative calculation essentially eliminates the effect of inflation in CMS’s estimates, resulting in $647 million in annual savings in perpetuity for purposes of the Executive Order.


Trump Administration Puts Patients Over Paperwork by Reducing Healthcare Administrative Costs