CMS has a new name -- now for a new attitude

AMA Leader Commentary. By Richard F. Corlin, MD. Sept. 17, 2001.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President Richard F. Corlin, MD.

We have a new secretary of Health and Human Services, we have a new administrator at the Health Care Financing Administration, and we have a new name for that agency -- the Centers for Medicare & Medicaid Services. It makes us hopeful that CMS has a new attitude toward physicians as well, because we are prepared to help make Medicare work better for patients and physicians.

During his confirmation hearings, Tommy Thompson, now secretary of Health and Human Services, acknowledged that HCFA had alienated members of both major political parties, and that the way the agency operated needed to be changed.

In and of itself, renaming the agency CMS merely adds a new acronym to our vocabulary.

But it's good to have an administrator for that agency who has experienced the problems firsthand. And we applaud the secretary for bringing a new attitude to the table.

In fact, Thompson and CMS Administrator Tom Scully have both indicated an openness to reform.

Early on, the Bush administration developed a list of 15 problem areas in Medicare to resolve, called the "Physician Issues Project." The list includes several high-priority issues for the AMA.

One is frequent Medicare denials of coverage for preoperative evaluations. CMS has sent new instructions to its contractors telling them that preoperative evaluation are to be treated as covered services by Medicare.

And last month, CMS issued instructions to Medicare carriers to curtail the use of random prepayment audits of physicians' claims as part of their medical review efforts.

Thompson also recently announced the creation of a task force to simplify evaluation and management documentation guidelines. In fact, CMS has temporarily halted work on the third set of E&M guidelines -- to ensure that the guidelines will help, and not hinder, the delivery of care.

These announcements are largely the result of the continued efforts of organized medicine.

The AMA and more than three dozen medical specialty societies also asked CMS to reconsider its commitment to the documentation guidelines and to problematic "clinical examples." Together, we demonstrated that the guidelines were not relevant to typical physician-patient encounters, they were inconsistent, they used clinical language that is seldom used in physician medical records and they excluded major patient groups.

Thompson listened, making good on his promise to be responsive to the concerns of physicians.

And his proposal for a task force to study this issue could not have come too soon. As we all know, all too well, the present system is unworkable. The rules demand that we create voluminous, repetitive, redundant and unnecessary progress notes, so much so that it is becoming impossible to get important information from patient charts. This in turn interferes with quality of care, particularly in urgent situations. It also forces physicians who are trying to protect their patients into an adversarial relationship with CMS.

The task force created to study this issue would be wise to take an approach that recognizes common sense and real-world experience in treating patients. And CMS needs to understand that, when it comes to E&M services, all we need is a mechanism to ensure that what is written on the bill is what was actually done. Nobody can argue with that.

We have also been heartened by Thompson's announcement that CMS will conduct a thorough review of Emergency Medical Treatment and Active Labor Act.

We are advocating that CMS return EMTALA to its original intent so that it applies only to real emergency department settings, not to other health care settings.

And all federal health programs should provide payment for "screening and stabilization" services.

Thompson's commitment to lift some of the administrative burden from the backs of physicians is encouraging. But we are keeping our eyes -- and our ears -- open. We continue to hear about the abusive tactics used by Medicare contractors when they audit physicians. And Medicare rules, policies and paperwork have grown at an exponential rate.

These are just two of the many reasons for Congress to approve the Medicare Education and Regulatory Fairness Act -- MERFA. It's legislation essential to freeing doctors from unnecessary and punishing red tape.

The AMA and the major specialty societies stand ready and willing to help improve CMS. Just as we always have been. Instead of being forced to be their adversaries, as has too often been the case in the past, we can work together as advocates for patients. With a new administration and a new name, maybe, just maybe, a new, cooperative attitude at CMS is also on the horizon.

But they will need to prove it to us first.

What do you think?

Dr. Corlin, a gastroenterologist in private practice in Santa Monica, Calif., served as AMA president during 2001-02.