CMS changes physicians want to see

The current healthcare landscape makes it difficult for physicians to turn a profit, and many leaders feel CMS' policies are contributing. 

Eight physician leaders joined Becker's to discuss changes they would like to see CMS make. 

Editor's note: These responses were edited lightly for clarity and brevity. 

Andrew Kaplan, MD. Director of Electrophysiology and Clinical Research at the Southwest Cardiovascular Associates (Mesa, Ariz.): I wish that CMS would remove the financial and regulatory barriers that inhibit the ability of independent physicians to compete with hospital health systems, especially in migrating appropriate procedural services to the outpatient setting and allowing physicians from different groups and across specialties to collaborate financially without having to work as a single megagroup. Patients are interested in best outcomes and cost savings. They also appreciate the close relationships they share with their physicians. We are under constant financial pressures and need environments which help us continue to thrive and maintain independence. This is better in many ways for the health system as a whole.

Carl Dettwiler, MD. Gastroenterology Specialist at Clearwater Gastroenterology and Gem State Endoscopy (Lewiston, Idaho): [CMS should] severely limit prior authorization requirements. While Medicare is not as bad as some commercial insurances, the whole concept has gotten out of control. In 36 years, I can only recall one time I could not get the test approved I wanted. Prior authorization increases the cost of medical care by increasing office expenses to get the tests and care needed for the patient. The physician general knows better than some insurance high school graduates what is best for patient evaluation and treatment.

Taizoon Baxamusa, MD. Orthopedic Surgeon at the Illinois Bone & Joint Institute (Barrington): As CMS really pushes to reimburse value-based care rather than traditional fee for service, our focus has really been at reducing costs for a diagnostic episode. We are best able to control these costs through our relationships with freestanding ambulatory surgical centers and home health agencies. Reducing the regulatory burden of fear of Stark violations would streamline the provision of care rather than money spent on administrative tasks.

Stephen Swetech, DO. Family Practice Physician in Clinton Charter Township, Mich.: CMS must remove its draconian opioid guidelines which are improperly given force of law. Physicians are blocked from treating legitimate pain-suffering patients. The arbitrary limits of opioids to seven days for acute pain just prevent physicians from delivering quality care to our patients. 

H. Parker Eales. Executive Consultant in Chapel Hill, N.C.: CMS would do well to abandon the MIPS Quality measures program — it is profoundly expensive by consuming an enormous amount of staff time and effort; bureaucratic; professionally meaningless to physicians in terms of relevant quality; and demoralizing in its constant changes and lack of real rewards.

Jeff Zilberfarb, MD. Orthopedic Surgeon at Meeks & Zilberfarb Orthopedics Associates (Brookline, Mass.): I would like CMS to allow outpatient total shoulder arthroplasty procedures. as this would allow these procedures to be performed less expensive than in a hospital.

David Hardin, MD. Chief of Medical Innovation at Healogic (Denver, Colo.): I wish CMS would decrease the burden for physician-owned enterprises under Stark and Affordable Care Act prohibitions. With removal of physicians from healthcare investment, we have seen quality and patient care suffer with costs continuing to rise. This is worst in hospital services, as the largest sector of spending for healthcare. Data has shown physician-owned hospitals to be better for both patient care and costs of care.

Grace Terrell, MD. Primary Care Physician at Atrium Health Wake Forest Baptist (Winston-Salem, N.C.): The one regulatory change that could benefit physicians and their patients the most is the classification of chronic care management codes as a preventive service (thus with no copay) rather than as an evaluation and management service. That would eliminate the monthly copay associated with these codes, which is an administrative burden for their use and a barrier to patient acceptance of care processes that occur in between in-person ambulatory visits. CMS states this will require an act of Congress to remedy, but it is stuck in committee. If Congress reexamined payment regulations around preventive services such as vaccines and chronic care management more holistically, there could be significant progress in transforming the CMS regulatory constraints that push care to in-person interactions that encourage overutilization versus whole-person chronic management innovations.

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