Four Things to Know About CMS’ “Patients Over Paperwork” RFI


By: Anna M. Timmerman and Timothy J. Fry – McGuire Woods

The Centers for Medicare & Medicaid Services (CMS) recently took the next step in its Patients Over Paperwork initiative by publishing a second request for information (RFI). This RFI seeks public comment by Aug. 12 on ways to reduce unnecessary administrative burdens. This solicitation intends to build on CMS’ past changes working toward its Patients Over Paperwork goals by seeking further concepts the agency can tackle. CMS believes these efforts will increase quality of care, lower costs, improve program integrity and make the healthcare system more effective and accessible.

With such stated goals, any responses to the RFI can address an expansive list of issues — indeed, CMS asks the public for comment on a variety of topics. Here are four important things to know about this initiative and where it seems to be heading with this RFI.

1) What Is the Patients Over Paperwork Initiative?

In October 2017, CMS and the Trump administration announced Patients Over Paperwork, their initiative to decrease 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 Administrator Seema Verma hopes cutting red tape will reduce the time providers must spend doing paperwork so there is more time to treat patients, thus improving care.

2) What Is CMS Targeting?

CMS’ target is broad — namely, any administrative practices, policies and rules, including subregulatory guidance and other agency efforts, that are unnecessary or duplicative. CMS states in the RFI, “Our continued goal is to eliminate overly burdensome and unnecessary regulations and subregulatory guidance in order to allow clinicians and providers to spend less time on paperwork and more time on their primary mission — improving their patients’ health.” CMS’ statement further exemplifies how CMS is making changes by pointing out its strategy of “modernizing or eliminating outdated regulations to remove barriers to innovation.”

CMS has already sought public engagement in such efforts. Before this second RFI, CMS previously published a request for information, conducted interviews with over 2,000 clinicians, administrative staff and leaders, as well as conducted other on-site visits and engagements. These prior efforts provided CMS with more than 1,100 burden topics the agency has sought to address.

3) CMS Has Already Made Strides in These Goals.

Since launching Patients Over Paperwork, CMS reports that it has “resolved or [is] actively addressing over 80 percent of the actionable RFI burden topics through changes to [CMS] regulations, subregulatory guidance, operations, or direct education and outreach to providers and beneficiaries.” CMS has kept the public engaged in this effort in various ways, including publishing nine newsletters and launching a new podcast. Here are some examples of areas where CMS has taken action:

  • Reducing regulatory burden, such as eliminating the requirement that facilities review their emergency plans annually (now required every other year) and eliminating the requirement that physicians continue to certify how long patients need skilled services in home healthcare
  • Simplifying documentation requirements, including allowing teaching physicians to certify student notes instead of mandating separate notes from the teaching physician as well, and allowing verbal orders for durable medical equipment, prosthetics, orthodontics and supplies
  • Focusing on meaningful measures, such as reducing required Merit-based Incentive Payment System (MIPS) measures
  • Improving operational efficiencies and interoperability, such as consolidated data submission for MIPS reporting and changes to the Medicare electronic health records (EHR) incentive program on interoperability
  • Enhancing transparency and consistency, such as major changes to the local coverage determination process
  • A new Medicare enrollment application for clinical professionals intended to streamline the enrollment process

4) CMS Requested More Ideas.

In publishing this second RFI, CMS is requesting additional input from providers, staff and the public to continue its Patients Over Paperwork efforts. CMS noted that ideas may include the following:

  • Modifying reporting or documentation requirements, or implementing new processes to monitor regulatory compliance
  • Aligning Medicare, Medicaid and other payor coding, payment and documentation requirements and processes
  • Enabling operational flexibility, feedback mechanisms and data-sharing that would enhance patient care, support the clinician-patient relationship and facilitate individual preferences
  • Recommending ways CMS can simplify rules and policies for beneficiaries, clinicians and providers, as well as when and how CMS should issue such regulations and policies

CMS specifically requested ideas on the following topics:

  • Improving the accessibility and presentation of CMS requirements for quality reporting, coverage, documentation or prior authorization
  • Addressing specific policies or requirements that are overly burdensome or not achievable, or cause unintended consequences in a rural setting
  • Clarifying or simplifying regulations or operations that pose challenges for beneficiaries dually enrolled in Medicare and Medicaid and those who care for such beneficiaries
  • Simplifying beneficiary enrollment and eligibility determination across programs

Commenters should remain aware that CMS cannot overrule congressional mandates, but CMS can re-evaluate its own regulations and other guidance, practices and policies.

In addition to furthering CMS’ Patients Over Paperwork initiative, responses to this RFI may be an opportunity to help CMS consider its regulatory process, particularly in light of the recent Supreme Court decision, Azar v. Allina, which eliminated a subregulatory policy impacting hospital payment. As noted above, CMS specifically mentioned it would look for recommendations on when and how to issue regulations and policies. With the Supreme Court’s decision focusing on past subregulatory guidance, CMS may look at such recommendations more closely.

More broadly, through this second RFI, CMS aims to continue identifying burdens that providers face when seeking to serve Medicare and Medicaid beneficiaries. Such efforts are widespread within the Trump administration and the U.S. Department of Health and Human Services, including changes to its Section 1557 nondiscrimination rules, as discussed in McGuireWoods’ May 30 and June 26 client alerts. Anyone looking to submit information to CMS can do so by 5 p.m., Aug. 12, 2019. Please consult one of the authors if you would like to submit information to CMS or to discuss the implications of the Patients Over Paperwork initiative.