AMA identifies Medicare's top regulatory burdens

More than 2,000 physicians provided input for a letter outlining rules that they say drive up practice costs and reduce time with patients.

By Charles Fiegl — Posted April 21, 2011

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Eliminating various unfunded mandates, restoring Medicare payment for consultation services and better aligning quality incentive programs would reduce the regulatory burden placed upon physician practices, doctors say.

The American Medical Association outlined these complaints and more in a letter to the Centers for Medicare & Medicaid Services on April 13. On Jan. 18, President Obama requested input on how his administration could reduce the regulatory burden on various sectors of the U.S. economy. The AMA responded by conducting a survey in which more than 2,000 doctors provided feedback on federal rules that they said increase administrative costs at their practices and interfere with patient care.

The AMA's nine-page letter requests relief from unfunded mandates in the Medicare program.

"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," AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, wrote in the letter.

The unfunded mandates listed in the letter are:

  • The required use of translators for Medicare and Medicaid patients with hearing impairments or limited English proficiency.
  • Medicare drug plan authorizations, such as formulary changes and pre-authorization requirements.
  • Expansions to the Emergency Medical Treatment and Labor Act.
  • Documentation and certification requirements that cause physicians to over-document during patient encounters.
  • The outdated Medicare Economic Index, a measure of inflation that understates the true cost of medical practice in the 21st century.

Physicians said the elimination of consultation billing in the Medicare program had caused significant strains on practices. According to the survey, 48% found they bill lower-valued visit codes now that the Medicare agency has banned the use of consult codes. "This puts Medicare at odds with the policies of most private payers and creates considerable confusion and administrative complications when physicians bill secondary payers for consultations," Dr. Maves wrote. The AMA urged CMS to reinstate payment for consultations.

Physicians called on the Medicare agencies to eliminate inconsistencies in its quality reporting programs. For instance, measures in the Physician Quality Reporting System program have different criteria than similar measures in the electronic medical record incentive program.

On the same day the AMA sent its letter, the Dept. of Health and Human Services published a notice in the Federal Register soliciting comment on which of its regulations should be modified, streamlined, expanded or repealed. HHS is accepting comments, which must refer to the file code HHS-ES-2011-001, through May 12. Comments can be submitted online (link).

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