Unfunded federal mandates, the elimination of Medicare payment for physician consultations, and incompatible and inconsistent quality initiatives offer a roadmap for the Centers for Medicaid and Medicare Services (CMS) to make strategic changes that benefit the entire Medicare system, according to a letter sent to CMS by the American Medical Association (AMA).
The contents of the letter, which cites those federal regulations physicians consider most onerous and offers suggestions on how to improve them, were derived from a member survey conducted by AMA in response to President Barack Obama’s call for an analysis of rules with an eye to reducing regulatory burdens. More 2,000 physicians responded to the request for feedback, according to AMA President Cecil B. Wilson, MD. “Thousands of physicians have answered the AMA’s call to identify federal rules and regulations that create significant burden for their practices and take up time that is better spent with patients,” Wilson says.
According to the letter, three out of five survey participants said unfunded mandates, such as drug plan authorizations, the Emergency Medical Treatment and Labor Act and documentation and certification, are the most onerous regulations.“Over the years, Medicare has demanded that physicians take on a panoply of duties aimed at achieving social justice and protecting Medicare from potential fraud by other providers,” the letter states. “While these requirements generally have laudable goals, costs frequently exceed benefits and are simply unrealistic in a program which fails to recognize the cost of practice changes implemented after 1973 and which threatens physicians with cuts of nearly 30% next year.”
Medicare’s prohibition of consultation code ranked as the second-biggest concern for 48% of respondents, with the AMA recommending that payment for consultations be reinstated. The prohibition on such codes, notes the letter, forces “physicians to bill for these services with lower-valued visit codes”, leading to administrative complications and revenue decreases.
Additionally, more than one out of five respondents believe the reporting requirements for the three incentive programs currently available to physicians – Physician Quality Reporting System, e-prescribing, and Meaningful Use of electronic health records – are inconsistent. The AMA suggested eliminating the inconsistencies.
The large number of audits and inconsistent auditing policies are also a burden, say 19% of survey respondents. At the very least, the AMA’s letter states, regulations that control these programs should be coordinated to maximize net benefits.
Other respondent concerns include complications of CMS’ enrollment program and administrative provisions, implementation standards and operating rules for the exchange of information electronically, not receiving timely feedback from CMS, inadequate education and outreach to physicians from CMS about new requirements, and issues with CMS’ pain management regulations for skilled nursing facilities.