3 changes Medicare is making to put patients back at the center of care

AMA Wire
Andy Slavitt
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Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt Monday said that the agency’s 2016 agenda is a busy one, but CMS will focus on the physician community’s input and a collaborative future that provides better care for patients.

“I think about our agenda not only in terms of how it impacts life for patients and their physicians and caregivers today but also in how CMS can set a tone to work constructively with [physicians] for years to come,” Slavitt said to hundreds of physician leaders at the AMA National Advocacy Conference in Washington, D.C.

“Our charge at CMS is clear,” he said. “Meeting the evolving needs of the 140 million Americans [covered by the Medicare, Medicaid, CHIP and Marketplace programs]. Most [are] on low or fixed incomes, whether they are living with a disability, trying to afford a prescription or are in need of coverage as they look for a better job. These are the people we serve every day, and these are the people that I wake up every day thinking about.”

Slavitt laid out the three focus areas that CMS will apply to its work with the physician community throughout the year ahead:

Listening to physicians

“Our first priority for 2016 is opening the lines of communication and listening to the physicians and other clinicians who provide our care,” Slavitt said, backing up his claim in January that the agency is changing its culture to focus more on listening to physician needs and giving them the freedom they need to keep patients at the center of the practice of medicine. 

CMS must “get a better and more direct feel for what is happening on the front lines of care delivery,” he said. “Good policy must be ultimately informed by the impact it has at the kitchen table of the American family and in the clinic or office where they seek care.”

“It is clear from listening to physicians there is fatigue,” he said, “with change, with measurement, with new requirements that come from the outside and aren’t simple to implement.”

“We are soliciting an unprecedented amount of direct physician input as we work to implement the Merit-Based Incentive Payment System (MIPS) payment models,” Slavitt said. “This will be a journey for all of us—one that requires a trusted partnership underpinned by honest, productive dialogue that helps each of us meet our common goal of better patient care.”

“I’m optimistic that this first objective—listening better to what happens in daily practice—is not just a passing idea,” he said, “but will make real lasting change on how things are done at CMS far beyond my tenure.”

Simplifying: Reducing the burden and give physicians more time with patients

“I visited with a physician in suburban Massachusetts a month or so ago,” Slavitt said. “The visit painted a vivid picture of the gulf that can exist between public policy—even well-intended and good public policy—and what it feels like on the front line of practice.” 

This physician was in a busy practice with just one other doctor. “I asked the physician to take me through a typical day and his interactions with technology and measurement and how it helped and hindered his interactions with patients.”

“He was very pleased to have technology in his office,” Slavitt said. “But it didn’t do the thing[s] he needed most, like give him feedback on referrals he made, and it required a fair amount of effort from him that took time but didn’t add a lot to patient care. He also discussed his interactions with various commercial health plans and with CMS and with payment model changes and administrative burden.”

“We must reduce [this] burden and give physicians back more time to spend with patients,” Slavitt said.

Supporting change in care delivery

“We believe we need to move back to a place where we are paying for doctors to talk to patients about their health, not just paying for new technology, devices, surgeries and prescriptions that have certainly been dominant drivers over the last number of years,” Slavitt said.

“Last year, with active support from the AMA, we began paying for advanced care directive conversations,” he said. “While this was seen as big news and a step forward in dealing with an area with lots of strong views, there is other news I hope you take away as well: And that’s the value we place on conversations between the patient and their doctor.”

“We are committed to building a program that is as flexible as possible and adapts around the goal of a provider’s individual practice and patient population,” he said. “If you commit to continually providing the input, we will commit to continually improving [the program].”

On the technology front

Slavitt announced that CMS will be sharing details and inviting comment as they roll out proposed regulations this spring implementing the Medicare Access and CHIP Reauthorization Act of 2015. The proposed regulations will include changes to the meaningful use program. He said these regulations will be guided by four principles:

  • Allowing physicians the flexibility to customize goals to their individual practice needs.
  • Rewarding physicians for the outcomes technology helps them achieve with their patients, not for using technology alone.
  • Leveling the technology playing field to promote innovation. This way, new apps, analytic tools and plug-ins can be connected to address the “lock that early EHR decisions have created for some practices,” he said.
  • Prioritizing interoperability by implementing standards and focusing on real-world uses of technology. “Business models that prevent and inhibit data from flowing to where the patient needs to go will not be tolerated,” he said.

In November, the AMA and 100 state and specialty medical associations submitted 10 principles to guide the foundation of the MIPS. The AMA also provided detailed comments (log in) as part of its ongoing efforts on this issue.

Additionally, the AMA continues to drive home the message that the problems inherent in the meaningful use program must not be adopted into the MIPS. The AMA recently submitted a detailed framework for what needs to change in meaningful use and continues to advocate for improvements.

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So finally it is recognized that patients have not been the center of care. It took a while, over a couple of years and congressional pressure. Also a legion of doctors whose spirits were Dilbertized, not to mention a few early retirements, a few suicides, and our President Stark to go to Bemedji and hear it from the peoples, and for Mr Slavit to go talk to a single suffering doctor to realize that template medicine where doctors do not look at patients is not a good idea. It sounds like the fable of the girl who said Toto we are not in Kansas anymore.
In addition to sending physicians reports regarding outpatient visits comparing office charges per patient, could we please see our patients' total expense to CMS (lab, imaging, consultations, emergency room visits, and hospitalizations)? Those physicians who spend more time in their office with patients may have higher office visit expense, but be saving the system elsewhere.
I think CMS should select the 10 areas per specialty that need improvement. Ask each specialty in medicine to work with CMS to identify the cost, risk, suffering, and preventive values of perhaps 30-50 diagnosis groups so as to sort down to those that make the most sense to address. Each sub specialty needs to be represented so as to allow all to engage meaningfully. .<br/> Then, the medical literature on those diagnosis groups should be reviewed and from that a best-practices model for each area should be developed. Each should invite comment based on published literature. As the process winnows to about 10 items per speciality, EHR companies should develop machine-learning-compatible models for each that allow anomized data sharing across the entire nation. From that, outcomes of management should advise refining best practices. As experience is gained, the numbers of diagnoses that develop best-practices algorithms should expand. Eventually, linking data from other physicians should be pertinent as the HPI gathering is guided by what machine learning has developed. Knowing for example that a person with conductive hearing loss has a family history of branchial-Oto-renal syndrome would help enormously in guiding diagnostics. <br/> We have to start using technology for the purpose of improving health care. Right now, the purpose of the technology appears to be billing-centric. While that, too makes some sense, at present, the focus has shifted away from quality care to quality of documentation relative to billing, not even relative to accuracy or diagnostic pertinence. <br/> And, with all of the above, engagement of patients in meaningful ways needs to improve.
I cut my Mediare and Medicaid slots from 30% of my practice to 10% when meaningful use penalties were started. This year I became non-par for Medicare. We recieve payment in full at the time of service for Medicare.<br/> <br/> I will not impliment EMR yet. The technology is not mature and it's potential is not yet realized. I will not see my notes degraded and I will not compromise the quality of my care in the exam room by staring at a computer instead of looking at my patient.<br/> <br/> I will be happy and successful caring for my little part of the 160 Million Americans without federal government controlled health care. You can do this too. You can tell Andy Slavitt to find another fool.
Well...well...well...CMS seems to have MISSED the real problem with 1 2 and 3. They do not mention TORT REFORM do they?
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