Physicians have had no reservations making their aversion to paperwork known, as evidenced by countless essays criticizing documentation requirements and the time management hurdles imposed by these steep expectations. Many discounted the protests of physicians, attributing their disdain to laziness; or something even more sinister: a scapegoat for non-compliance, errors, and even fraud. As the integration of EHRs became more ubiquitous and fraud fighting initiatives bolstered, the time imbalances between clinical care and administrative duties came to an all-time high – giving credence to physician’s pleas for an effective solution.
Earlier this year, the Washington Examiner published an article blaming bureaucracy for rising healthcare expenditures; reporting that physicians spend nearly 66% of their time on paperwork and EMR maintenance.
Centers for Medicare & Medicaid Services have made attempts at fixing these inequities – but their efforts thus far have been met with even more criticism. In a more recent attempt to correct these problems, the Trump Administration has proposed a massive shift in reimbursements. Under this proposal, Medicare will pay doctors the same amount of money for most common services (office visits), regardless of case complexity or patient condition. There will be differing fees involving new patients, and established patient visits. This is in effort to cut back on the time physicians spend on paperwork. Seema Verma, acting administrator of CMS has defended this proposal by estimating that each provider will save 51 hours of clinic time per year.
Of course, this solution is not without its opponents. This new payment structure opens up new opportunities for problems with providers and with CMS. From a physician perspective, doctors will more than likely be occasionally underpaid for working with patients who have more complex conditions and medical histories. This will dissuade some hopeful specialists from investing in the added education, and it will discourage some from treating Medicare beneficiaries all together. Patients will then suffer, either through longer wait times or by experiencing physician accessibility problems when they fall ill. Patients with a head cold will have more demands than a patient with Stage 4 cancer, and many are claiming that it is a gross oversight to consider their office visits equal.
The payment scale will also differ as a result of this proposed plan. Evaluation and Management levels will still be integral, though the fees for each level will experience a tectonic shift. Whereas a Level 2 office visits currently sit at $76, and a Level 5 is about $211; the new proposal establishes a single rate of $135. The rates for established patients will shift to a fixed median fee of $93. Not only do these new fees pose a problem for specialists and those with complicated patient populations, but they increase the risk of fraudulent payments. CMS may suffer at the hands of this new proposal by giving providers the opportunity to get paid more money with less documentation. Providers will be able to submit less and walk away with more, which suggests that they’ll be able to submit for procedures that may not have ever been performed.
While it seems that this proposal has already won the support of CMS – there may be an uphill battle ahead.