A number of recent studies, including one by JAMA., show that physicians are increasingly experiencing burnout and work stress – and much of the blame lies with the increased EHR reporting and related administrative requirements in the transition from fee-for-service to value-based care. In fact, four in ten doctors complain that these stressors have increased pessimism about practicing medicine – hardly the expected outcome by those behind the revisions and reforms.
It should be no surprise then, that reduction in EHR burdens are near the top of the wish lists for many healthcare providers and executives. Fortunately, CMS and HHS have been paying attention to the feedback and suggestions, and are in the process of taking steps as outlined in their draft strategy’s playbook, released in November 2018 to reduce reporting burdens as a requirement of the 21st Century Cures Act as described in more detail below.
The playbook focuses on three main goals: reduce clinician reporting, simplify inputting regulations, and increase EHRs’ usability.
The 21st Century Cures Act: an overview
Signed into law by President Obama, the 21st Century Cures Act aims to:
- Sets forth information-sharing guidelines as well as IT interoperability and spells out the ramifications for healthcare IT developers who engage in blocking information
- Create new protocols for the drug-approval process to expedite getting potentially life-saving drugs on the market as well as support the development of new drugs
- Provide funding for projects including the Cancer Moonshot, and Precision Medicine Initiative
EHR reporting: challenges and recommendations
In the HHS draft, numerous health IT and EHR-related burdens, including problems with accessing and extracting data, particularly from multiple systems, regulatory requirements not in line with real-world reporting and timelines, and overloaded records with excessive and unnecessary documentation.
Two main recommendations for better documentation include leveraging existing data in EHRs to reduce repetition in documentation in clinical notes as well as waiving documentation requirements as required to test or otherwise administer alternative models of payment.
As a result of provider feedback, a main focus of the CMS is to reduce chart-abstracted measures which require manual entry of reporting values by staff.
While many providers use the cut-and-paste templates to reduce time spent entering data, these can contribute to including outdated, inaccurate or unnecessary information into patient record.
IT and EHR designers will be encouraged to improve EHR alignment of workflow with that of the clinical real-world
Standardized medication and order entry information within the scope of health IT
Another goal is to incentivize more innovative ways of improving interoperability and IT overall by reducing provider reporting burdens
Healthcare IT usability
Harmonizing user actions across EHRs for basic clinical operations
Integrate open API approaches to the electronic administrative systems of HHS with advanced health IT products
The Medicare Red Tape Initiative
Begun in 2017, the Congressional Ways & Means Committee convened to draft strategies for reducing Medicare paperwork and reporting burdens for clinicians. Over the summer of 2018, the committee collected feedback from clinicians and other stakeholders regarding which policies impeded and which improved care quality. CMS has teamed with ONC to draft recommendations for reducing the above burdens and impediments to quality reporting while giving providers more time with their patients, while collaborating with clinicians and other stakeholders to further the goals of the Red Tape Relief Project.
The Office of the National Coordinator for Health Information Technology (ONC) acts as a resource for the whole health information system to aid in adopting health information technology as well as promote national health exchanges for improved health care. ONC is located organizationally within the Office of the Secretary for U.S. Department of Health and Human Services.
ONC Chief Clinical Officer Andrew Gettinger, M.D. and CMS Chief Medical Officer Kate Goodrich, M.D. wrote that “…clinicians have had to report (as many as) 30 measures to 7 different payers…” In addition, excessive copy-and-paste functions can lead to unnecessarily-long clinical notes which can make it harder for clinicians to access relevant patient and other clinical information in a timely manner.
Health IT Now, a coalition of patient groups, payers, providers and employers, has praised the acknowledgement by ONC of the EHR burdens faced by providers in documentation, reporting and usability as a worthwhile step in reducing clinicians’ burdens.
Provider feedback makes a difference
Over 150 clinicians groups as well as individual providers participated in meetings with committee members, as well as hospital representatives, home health advocates and agencies, major insurance organizations, drug and medical device groups, and numerous health information organizations have all contributed feedback to the project over the past year. Physicians have complained that the EHR Reporting Program, as well as the other federal incentive-reporting programs, all create unnecessary clinician burdens and are misaligned across the spectrum.
What’s ahead for 2019 and beyond
With the passage of the Bipartisan Budget Act of 2018, along with other regulatory changes lowering the administrative burdens associated with MACRA rulemaking for the coming calendar year of 2019 is still ongoing.
As we move through fall into the coming year, the Committee plans to continue to obtain feedback from stakeholders. They stress the importance of providers utilizing the current comment period, which ends at midnight January 28, 2019.
Making sense of changes: partner with a practice management and billing company
Templates, user-friendly software and reduced reporting rules all can be effective in saving busy providers time and effort while improving accuracy, but partnering with an experienced medical billing service, such as M-Scribe, can prove even more cost-effective. M-Scribe has been in the business of helping practices of all sizes and specialties with their practice management concerns and needs since 2002. Clinicians find they have more time to devote to patients while assuring that claims are sent out to the proper payer, meeting all payer guidelines in a timely manner. Contact us at 888-727-4234 or email to learn more about how we can help you remain compliant while managing your revenue cycle.