In this episode, we welcome back BESLER’s Mary Devine, Senior Director of Revenue Cycle, to talk about the 2017 Patients Over Paperwork initiative and where it’s at today.
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Highlights of this episode include:
- Cut the Red Tape executive order
- The goal of Patients Over Paperwork
- Health informatics
- Prior authorizations
- Physician documentation
Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance podcast. In 2017, the president signed an executive order to cut the red tape. This was signed in order to eliminate duplicative, unnecessary, and excessively costly requirements and regulations. This became known as Patients Over Paperwork, with a goal to put the patient first. Today, I’m joined by Mary Devine, senior director of Revenue Cycle here at BESLER, to talk more about that initiative and where it’s at today. Mary, welcome back to the show.
Mary Devine: Thanks for having me.
Mike: So, Mary, what is cutting the red tape? What’s that all about?
Mary: And I think when you started with the intro, that it was perfectly said, mostly that back in 2017, President Trump signed into in an executive order of cut the red tape. And as you mentioned, it really is to eliminate and minimize some of the burden of paperwork and regulatory requirements that all kinds of providers are forced to go with. So it was really kind of focused on minimizing steps that providers need to take while they’re doing patient care. And they wanted to make sure that their time was spent more caring for the patients than documenting the care that they gave. So in an example, if a physician writes up an admission summary and then they need to go do a discharge summary, and 24 hours later, they can reference a lot from the admission summary versus doing the discharge summary all over again, acting as if that documentation was never present. And really, by reducing the regulatory burden of redundant paperwork, providers can focus on patient care, and in turn, improve patient outcomes. It was expected to reduce costs by $6.6 billion and 42 million hours of clinicians’ time. So that right there tells you how much redundancy and regulatory requirements we have in place that take away from patient care.
Mike: Absolutely. And you enumerated a couple of the goals there, but in your point of view, what is the ultimate goal of Patients Over Paperwork?
Mary: The ultimate goal of Patients Over Paperwork, cutting the red tape, is to alleviate the regulatory burden for clinicians who are the foundation of healthcare, to support a healthcare system that offers high-quality care. The government must step aside some and let providers and clinicians focus on what benefits the patients. And ultimately, then the patients will have better outcomes when they have more time with the clinicians to focus on them versus writing up documentation.
Mike: That’s a good goal. Mary, let’s talk about some of the initiatives that were taken. Can you talk about a few of those for us?
Mary: Sure. So some of the accomplishments that were accomplished over the course of– so far, what’s been happening, and there’s still a lot more to come, they removed the burdensome conditions of participation. If you’re familiar with any of the conditions of participation that CMS has in place. And conditions of participation are not just for Medicare, but they’re for Medicaid, and they are also for the the CHIP program. So they eliminated some of the conditions of participation to make it easier to treat that patient and document what’s going on. They also removed 235 data elements from the OASIS Home Care form. That is a long, long form that, when a patient signs on for home care, the home health agency has to complete this OASIS. And it goes into all kinds of history of the patient and conditions of the patient and why they’re ultimately going out to see the patient. Why is the patient home-bound? And then this form needs to be updated on a regular basis and it has to get submitted to Medicare. So what they did is they removed 235 data elements, and that should tell you how much information is in this OASIS form. If they’re removing 235 elements and the form is still required and needed. They’re minimizing data elements for meaningful measures. Hospitals had to report meaningful measures as it relates to some of the information in the EHR, and they minimize a lot of what was going to be collected from providers in order to get to that.
And then finally, just another one to mention is whenever a state for Medicaid purposes wants to change something with their program or change some of the benefits they’re going to be offering, they need to submit a request to CMS in order to have that change made from a state perspective. So what they did is they really simplified the process and they also shortened it so that while they’re waiting for this change, which is, quite honestly, usually a positive change towards patient care, there’s not that delay and they can right away implement that change.
Mike: Mary, due to COVID and the PHE, did the waivers have any impact on this initiative?
Mary: As part of the 1135 blanket waiver that was called in place in March of 2020, way back when. So it seemed so long ago when the COVID-19 and the public health emergency was called. The Patients Over Paperwork really went into full swing. And as you read through a lot of the waivers that went into place that were impacting acute care hospitals, SNF, home care rehabs and clinicians. And through these waivers, the number one common theme across them all was the Patients Over Paperwork. And certainly, the overall theme, as I mentioned, for Patients Over Paperwork was to allow clinicians to better effectively treat patients. And really, with the waiver, they wanted to ensure that they wanted to minimize all kinds of redundant documentation, other paperwork, freeing up clinicians to treat patients so that when anybody wanted to be treated, there would be a clinician available. And that was the biggest thing with COVID, that they were concerned that there would not be enough clinicians in order to treat those patients. And that was the biggest theme throughout, and it really, really put some of the Patients Over Paperwork into the full swing.
Mike: Got it. And one of the things they talk about in the initiative several times is health informatics. Can you talk a little bit about that?
Mary: Yeah. I think health informatics is really a trendy word, and really what it is is it’s another word for health information systems, and it’s one of the biggest initiatives as it relates to Patients Over Paperwork. And in order for health informatics, it relies on information technology. And so they’re going to continue to really push this initiative to use information technology, and they want the individuals that work in the field to organize and analyze the health records to improve healthcare outcomes. So again, this is all focused on improving the outcomes of the patients, and they’re investing a lot of money into the interoperability of patients’ data. And so the idea of it all is that these patients will be able to basically carry this information wherever they go. It’s connected to smartphone technology with the application program interfaces. And so patients now, they can log on to their phones and they can quickly see any test results. And then in the same token, the physicians can log in to these interfaces and they can see information about the patient that they need to see. And one of the biggest areas is as it relates to the prior authorizations, and that’s kind of the big piece of it.
Mike: Yes, let’s talk about that, because prior authorizations, they’re a pain point for everyone involved. Did they address this?
Mary: Yeah, absolutely. And it was like a separate initiative underneath the focus on health informatics. And we can all remember times when you needed a prior authorization because you needed to have an ultrasound versus a regular X-ray. And you were at the hospital and you were waiting for it to get done, but you had to go home because the prior authorization wasn’t ready or, from a provider perspective, the prior authorization, you didn’t get the prior authorization, and the patient’s bill then gets rejected because there was no prior authorization to have that next procedure done. So with the interoperability and the APIs, they will much easier be able to obtain the prior authorization that’s needed because they’ll very easily log in, they’ll be able to look at the patient’s information as it relates to the need for that test, and then they can right away authorize that so then the patient can immediately have that. And when somebody asks for it, the patient can pull it up on their phone. So they really spent a lot of time focused on that prior authorization process to speed things along so patients aren’t waiting and they have better outcomes.
Mike: Is there anything specific in there regarding physician documentation?
Mary: Yeah, absolutely. With the Patients Over Paperwork initiative, it really simplifies E&M documentation required in the charge to support the care provided. So in the example I gave, the history can be shortened, the history and physical. When you go in to see a physician, they don’t have to do this long, lengthy history and physical documentation. They can reference those points that was done a week ago or two weeks ago or a month ago, and only update on what has changed. Now, that being said, it does not change the requirements of information needed to calculate the E&M code. So if you want to get to a level five, all the points need to be there. However, you can reference the information that was previously posted to that electronic medical record versus having to type it all over again.
Mike: Well, thanks for all this information, Mary. I know there’s a lot more to all of this. But this was a great summary, an overview of this particular initiative, and it sounds like there are some good things happening around it. So appreciate you coming back to the show to talk about it.