Statement of the Association of American Physicians and Surgeons
to the Secretary's Advisory Committee on Regulatory Reform,
Phoenix, Arizona, March 20, 2002
To accomplish the Advisory Committee's purpose of finding ways to reduce regulatory burdens and costs, AAPS suggests the following method:
Just do it! The regulatory burdens created by the HCFA/CMS and can simply be lifted by HCFA/CMS.
The complexity of the rules often goes far beyond the statutory authority granted by Congress and causes results contrary to the stated legislative purpose.
For data collection, the minimum data set for patient assessment should be defined by the physicians and nurses caring for the patient. For some patients, a great deal of data will be required: daily weights, frequent vital signs, periodic electrolyte measurements, dietary assessments, and so forth. For patients who are independent and in good health, very little information is needed.
CMS should not be engaged in the burdensome and intrusive function of dictating down to the finest detail what data should be collected. Sometimes the patients' caregivers collect or "document" too little data: they may not get paid for their work, find their visits downcoded, or even be accused of negligence solely on the basis of the record. Sometimes caregivers collect too much data, especially laboratory data, and are accused of providing "unnecessary service," for which they can be fined very heavily or even prosecuted criminally.
Several meetings at our hospital concerned the four pieces of essential data that had to be on the chart before an upper gastrointestinal endoscopy could be performed, solely in order to meet government standards. One of the four was an examination of the nasopharynx. Doctors almost never examine the nasopharynx, and few examining rooms are even equipped to do so properly. The endoscope goes through the mouth, not the nose. Doctors could name many other things not on the list that should be done, such as checking the teeth or the lungs, but their opinion was irrelevant.
Government data collection standards are of the one-size-fits-nobody type. For any individual patient, the mandated data set is too much in some areas, too little in other areas, and too stupid in all areas. Caregivers focus on mechanically filling in the boxes rather than in using their skills and intelligence to optimize the care of the patient. It is difficult, if not impossible, to do both at the same time.
And what are the government-mandated data used for? Potential uses include: (1) Trapping physicians or nurses who don't force their round peg into the square hole; (2) Creating employment for clerks to check the checkboxes even though they have no idea what, if anything, they mean; (3) Generating the garbage input that produces garbage output to officials who will plan and ration and micromanage the provision of care; (4) Supplying a rationale for not paying the bills and thus forcing medical professionals to make up for budget shortfalls that result from the government making promises that can by no means be kept.
In the Medicare statute signed into law in 1965, § 1801 states: "Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which Medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or per-son."
Dictating what examinations shall be done, and how they shall be recorded, is an intrusive micromanagement of the practice of medicine and is forbidden by law. Dictating how much the physician may charge, as distinct from determining the benefit that Medicare is to pay the recipient, is also forbidden by this law. CMS should not be collecting data that can only be used for an unlawful purpose.
The data that CMS needs are: patient's name, address, Medicare number, and a plain English description of the service provided. This information should suffice for writing a check to the Medicare beneficiary-the patient-who is responsible for paying the bill for the services rendered.
Helping Medicare beneficiaries pay their bills is supposed to be the sole function of Medicare.
If HCFA/CMS activities were restricted to this function, many benefits would accrue: (1) the deadweight administrative overhead for providing services would diminish dramatically; (2) the potential for fraud would be virtually eliminated; (3) more physicians would accept Medicare patients; (4) innovation would flourish.
If patients paid every bill directly, it would not be possible to bill for fictitious services through P.O. boxes. Like credit card fraud, Medicare fraud would be self revealing. There would be no place for creative fraud artists to hide behind paperwork complexity.
We urge you to seize this opportunity to make a real difference. We have suggested a methodology for evaluating regulations in our comments for the record, which are appended.
Jane M. Orient, M.D., Executive Director