Allow physicians to use electronic health records (EHRs) how they see fit, eliminate prior authorization requirements, lift the ban on physician-owned hospitals, and allow a real out-of-network option.
Those are among the 15 recommendations the Texas Medical Association presented to the Centers for Medicare & Medicaid Services (CMS), which is seeking to reduce administrative burdens and red tape in the Medicare program.
“Excessive administrative burden contributes significantly to physician burnout, reduces physicians’ desire or ability to participate in the Medicare program, and ultimately is detrimental to patient health,” TMA president David C. Fleeger, MD, said in a letter outlining the recommendations. “Effectively and aggressively implemented, the ‘Patients Over Paperwork’ initiative could reduce our nation’s surging health care costs and improve Medicare beneficiaries’ access to quality health care.”
CMS published its efforts in the Federal Register in June. After reviewing the proposed changes, TMA sent its recommendations to CMS lastweek.
Among TMA’s recommendations:
- Allow physicians to decide whether and how to use EHR systems. “Because EHR design enhancements are now focused on satisfying government requirements rather than medical practice or patient needs, the federal intervention in this marketplace has actually slowed the expected product improvement cycle,” TMA’s recommendations say. Instead CMS should allow physicians to decide which tools and methods to use, and require EHR vendors to compete for buyers.
- Remove current EHR requirements for reporting data in Medicare’s Quality Payment Program (QPP), which favor specific vendors who keep updating their software. “Those vendors should compete for physician business on a level playing field, based on the value of their products and services to the physician,” TMA’s letter said. “Small independent physicians should not be required to maintain the same type of EHR system as large integrated health systems.”
- Allow a real out-of-network option, including permitting Medicare beneficiaries to choose out-of-network physicians without foregoing all of their relevant Medicare benefits.
- Prohibit health plans from expanding their prior authorization requirements, and direct the plans to create a “gold card” system so that physicians whose prior authorization requirements are routinely approved would be exempt from the process.
- Provide antitrust relief for physicians. As more health plans consolidate, they are increasingly unwilling to negotiate terms or payment with individual physicians and small group practices. Instead, “physicians should be allowed to negotiate collectively with payers who have dominant market power,” TMA said. “Antitrust laws should be appropriately modified to facilitate fair physician negotiation with insurance plans.”
Last Updated On
August 19, 2019