There are various regulations and reforms in the past few years, introduced by the healthcare regulatory bodies such as Center for Medicaid and CHIP Services (CMS). The authorities vet eligible medical and healthcare providers for their compliance and reporting. Qualified physicians, who are not in compliance such as the Meaningful Use program, which is an incentive program for physician practices, critical access hospitals (CAH) as well as for eligible hospitals (EH). Similarly, they are not adopting new technologies like EHR (electronic health record), PQRS (physician quality reporting system), or eRx (electronic prescribing) would possibly be experiencing a reduction in their collections.
Annals of Internal Medicine study found that physicians spend ‘27 percent of their time with patients and 49.2 percent of their time on EHR and clerical activities. Outside of office hours, physicians spend another one to two hours of personal time each night on data entry demands.’ Although the incorporation of new technologies like EMR, EHR and Practice Management tools were meant to optimize the system with universally connected technologies but ground realities are different. These software technologies are not only limiting the time providers used to spend with patients; they are allowing less time to see more patients and result in fewer collections and reimbursements.
MACRA aka the Medicare Access and CHIP Re-authorization Act of 2015 substituted the current fee for programs related to documentation of services with the Merit-based Incentive Payment System (MIPS) which is one of the initiatives by the Quality Payment Program that drive Medicare Part B contributors to a payment system based on performance. With the launching of MIPS, there happened to be the fortification and reinforcement of the Value-Based Modifier (VBM) programs, Physician Quality Reporting System (PQRS), and Meaningful Use (MU), while freeing them from their particular systems.
To get the reimbursements, qualified physicians are now required to comply with the Value-Based Payment program by the CMS or face penalties. Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare. The Value-Based Payment program is transforming the way physicians use to get paid which was formerly by the number of visits and tests they order (fee-for-service). Now, healthcare providers would be reimbursed for the value of care they deliver (value-based care). Although these regulatory programs and reforms are meant to improve the current healthcare infrastructure, somehow these are severely reducing the collections, and most of the providers are not able to pace with the rapid changes and are consequently missing their revenue targets.
According to a study by UCLA’s Gregg Fonarow, “It’s possible that doctors may have made treatment decisions designed to avoid readmissions rather than to give patients the best possible care.” Coupled with the burden of financial penalties if a provider is not able to meet the required criteria, it is a burning issue for many providers. Therefore, the American Medical Association has petitioned itself to voice the legitimate concerns. In this regard, the AMA has requested the CMS to establish ways out for implementation of these set of rules in a relatively trouble-free way. The primary purpose of requiring CMS for more flexible regulations is to free the eligible physicians from extra burden of compliance and focus on delivering quality care services. As a result, the government has recently signaled a more flexible approach to achieve the regulatory objectives. If approved by the Senate, the new healthcare bill would aim it setting physicians and healthcare providers free from the compliance burden and bring in a more realistic transition over the time.