Patients over Paperwork: A Journey Forward

>> GOOD MORNING, EVERYBODY I’M DR. MARY GREEN. I LEAD THE PATIENTS OVER PAPERWORK INITITIATIVE ALONG WITH DR. KATE GOODRICH UNDER THE SUPERVISION OF ADMINISTRATOR VERMA THANK YOU FOR JOINING US TODAY AS WE CELEBRATE THE WORK DONE TO DATE ON PATIENTS OVER PAPERWORK AND WE LOOK FORWARD TO MORE THINGS WE CAN DO BEFORE I INTRODUCE THE ADMINISTRATOR, I WANT YOU TO TAKE A LOOK AT YOUR AGENDA QUICKLY AND JUST KNOW THERE’S A HASHTAG AT THE BOTTOM, IF YOU ARE A LIVE TWEETER, YOU ARE WELCOME TO DO THAT THE HASH TAG IS AT THE BOTTOM OF THE AGENDA I WOULD LIKE TO INTRODUCE CMS’S ADMINISTRATOR, SEEMA VERMA [ APPLAUSE ] >> ALL RIGHT HELLO AND THANK YOU FOR JOINING US TODAY AS WE MARK THE 2-YEAR ANNIVERSARY OF ONE OF OUR SIGNATURE INITIATIVES PATIENTS OVER PAPERWORK I WANT TO PAUSE TO THANK CONGRESSMAN BOUCHARD AND BOURGES FOR THEIR ATTENDANCE TODAY THEY ARE KEY PLAYERS IN THE EFFORT TO DELIVER A HEALTHCARE SYSTEM THAT WORKS FOR PATIENTS AND THEIR CONTRIBUTIONS AND SUPPORT FOR CMS ON THIS INITIATIVE HAVE BEEN INVALUABLE AND WE ARE EXTREMELY GRATEFUL AND THANKFUL THEY WILL BE DELIVERING A FEW WORDS IN A MOMENT AND LOOK FORWARD TO HEARING FROM THEM LAUNCHED IN 2017 PATIENTS OVER PAPERWORK IS THE CENTRAL PLANK OF CMS’S ONGOING CONTRIBUTION TO PRESIDENT TRUMP’S ORDER TO CUT THE RED TAPE SINCE THAT TIME WITH RECENT EXECUTIVE ORDER ON MEDICARE WE HAVE SEARCHED HIGH AND LOW FOR DUPLICATIVE AND UNNECESSARY PAPERWORK IT REAMS PRESCRIPTIVE GOVERNMENT REGULATION THAT’S DICTATE PROCESSES WHERE THE HEALTH SYSTEM HAS FAILED REGULATIONS SHOULD IDENTIFY EXPECTED OUT COMES RESULTS AND STANDARDS NOT MICROMANAGE EVERYTHING THAT THE HEALTH INDUSTRY DOES AND PATIENTS BELONG AT THE CENTER OF THE HEALTHCARE SYSTEM AND FOR TOO LONG THEY HAVE BEEN SHUNTED ASIDE AS MOUNTAINS OF PAPERWORK HAVE COME FIRST $266 BILLION A YEAR COULD BE ATTRIBUTED TO ADMINISTRATIVE COSTS SO WE HAVE LAUNCHED THIS INITIATIVE TO RIGHT THE SHIP BY GETTING RID OF OUTDATED REGULATIONS THAT DON’T MAKE SENSE AND EACH PROVIDER BURDEN REDUCE ADMINISTRATOR COSTS AND PUT PATIENTS FIRST THE PROCESS BEGAN WITH A WIDE- RANGING REQUEST FOR INFORMATION WE DID IN 2017 AND YIELDED OVER 3,000 DISCRETE DATA POINTS RELATED TO OVER 1100 DIFFERENT ISSUES AND TO DATE, I’M PROUD TO REPORT WE HAVE ACTED ON, OR ARE WORKING ON OVER 80% OF THE ITEMS MENTIONED WITH THE REMAINDER OF THOSE FALLING OUTSIDE OF CMS’S PURVIEW IN AUGUST OF THIS YEAR WE RECEIVED OVER $560 SUBMISSIONS TO A NEW R.F.I. WE ARE CURRENTLY ANALYZING IN ADDITION, WE HAVE ACTUALLY GONE OUT TO THE FRONT LINES TO UNDERSTAND THE IMPACT OF OUR REGULATIONS THE PATIENTS OVER PAPERWORK INITIATIVE HAS PUSHED THE CMS TEAM TO TAKE A NEW APPROACH TO RULE MAKING GETTING OUR STAFF OUT OF THE OFFICE AND SEEING HOW THEIR WORK TRULY AFFECTS PROVIDERS CLINICIANS, STAFF AND BENEFICIARIES AND BY GENUINELY LISTENING TO THE CONCERNS OF STAKEHOLDERS GOVERNMENT IS FACILITATING INNOVATION RATHER THAN STYMYING IT IT’S ALLOWED US TO CONDUCT 800 INTERVIEWS, 185 WITH SUBJECT MATTER EXPERTS AND 182 LISTENING SESSIONS ACROSS THE NATION WHILE THERE’S MUCH MORE TO BE DONE WE HAVE MADE CONSIDERABLE INROADS AND BEFORE PREVIEWING WHAT WILL COME IN THE FUTURE I WOULD LIKE TO GIVE YOU A BRIEF TOUR OF SOME OF THE HIGHLIGHTS OF THE WORK DONE SO FAR WE RELEASED OMNIBUS REDUCTION PROPOSED MODERNIZATION OF REGULATIONS IMPLEMENTING THE STARK LAW THE OMNIBUS RULE AFFECTED PROVIDERS ACROSS THE HEALTHCARE SYSTEM, REMOVED MEDICARE REGULATIONS THAT STOOD LIKE A BRICK WALL BETWEEN PATIENTS AND THEIR DOCTORS AND DID NOTHING TO ADVANCE PATIENT HEALTH AND SAFETY BY ITSELF THAT RULE WILL SAVE

$800 MILLION AND 4.4 MILLION BURDEN HOURS IN OUR LISTENING SESSIONS STARK WAS CONSISTENTLY RANKED AMONG THE TOP CONCERN OF PROVIDERS AND CLINICIANS AND SO OUR PROPOSED RULE RESPONSE TO THESE CONCERNS, IT EASES THE REGULATORY BURDEN ON VALUE BASED ARRANGEMENTS AND PROVIDES BADLY NEEDED NEW GUIDANCE TO HELP COMPLIANCE BURDEN UNDER THE STARK LAW AND WE RELEASED A PROPOSED RULE THAT APPLIES TO NURSING HOMES I CAN TELL YOU I REMEMBER VISITING A NURSING HOME A COUPLE YEARS AGO AND THE STAFF BROUGHT ME MULTIPLE MASSIVE BINDERS OF PRINTOUTS OF LITANY OF OUTDATED RULES THAT SEEMED TO DICTATE EVERYONE OF THEIR DECISIONS THE NURSING HOME RULE IN PARTICULAR WOULD SAVE $616 MILLION, MONEY THAT COULD BE REINVESTED BACK INTO PATIENT CARE AND WHILE PHYSICIAN BURN OUT REMAINS VERY HIGH, WE ARE TURNING OUR ATTENTION TO THAT ISSUE LAST YEAR WE MADE HISTORIC PROPOSALS TO SIMPLIFY HOW DOCTORS DOCUMENT, EVALUATION AND MANAGEMENT CODES USED TO BILL MEDICARE AND THOSE CODES HAVE BEEN IN PLACE FOR OVER 20 YEARS AND WE ARE CONTINUING THAT WORK THIS YEAR ADDITIONALLY, TO MAKE IT EASIER FOR TEACHING PHYSICIANS TO TRAIN THE NEXT GENERATION OF DOCTORS WE INCREASE FLEXIBILITY FOR MEDICAL STUDENTS TO PUT INFORMATION INTO THE ELECTRONIC HEALTH RECORDS AND WE HAVE PROPOSALS TO EXTEND THIS POLICY TO OTHER CLINICAL TEACHERS LIKE PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS I ALSO WANT TO HIGHLIGHT OUR MEANINGFUL MEASURES INITIATIVE IT FOCUSES PARTICULARLY ON QUALITY RATHER THAN PROCESS OF GETTING RID OF MEASURES THAT WERE OUTDATED AND THAT MEANS CUTTING ACCUMULATED PROCESS REQUIREMENTS THAT DON’T PRIORITIZE PATIENTS AND THROUGH THAT EFFORT WE HAVE ELIMINATED 79 MEASURES ACROSS THE SYSTEM FOR PROJECTED SAVINGS OF $128 MILLION AND $3.3 MILLION BURDEN HOURS THROUGH 2020 AND WE ARE NOT DONE WE PROPOSED COMPLETELY REVAMPED PROGRAM, A NEW PROCESS THAT WOULD ALLOW US TO CREATE MEASURE IN PARTNERSHIP WITH MEDICAL PROFESSIONAL SOCIETIES WE HAVE ALSO PLACED AN UNPRECEDENTED PRIORITY ON STRENGTHENING THE RURAL HEALTHCARE SYSTEM SO UNDER OUR RURAL HEALTH STRATEGY WE ARE APPLYING A LENS TO THE VISION AND WORK OF CMS INVESTIGATING A WAY TO ALLEVIATE FOR PROVIDERS REDUCE ROLE OF SUPERVISION FOR HOSPITAL SERVICES TO MAKE IT EASIER FOR RURAL HOSPITALS TO PROVIDE ACCESS TO THESE SERVICES WE WILL HAVE A SESSION ON THAT TODAY SO WE LOOK FORWARD TO HEARING MORE FROM YOU ABOUT HOW WE CAN GO EVEN FURTHER ON THAT EFFORT AND IT’S IMPORTANT TO NOTE WE ARE TAKING CARE OF EFFORTS TO CUT BACK ON NEEDLESS REGULATORY REQUIREMENTS AROUND PROGRAM INTEGRITY OUR EFFORTS HAVE REDUCED PROVIDER BURDEN AND APPEALS TO AN ALL-TIME LOW BUT THERE IS CERTAINLY MORE WORK TO BE DONE SO WE ARE WORKING ON SOMETHING CALLED DA VINCI PROCESS, PRIVATE SECTOR INITIATIVE FOCUSED ON DATABASE STREAM TO STREAMLINE ACCESS TO RECOVERY PROCESS I CAN GO ON AND ON ABOUT THE CHANGES BUT ALL TOLD OUR REDUCTION EFFORTS HAVE SAVED THE ENTIRE SYSTEM $6.6 BILLION AND 42 MILLION BURDEN HOURS THROUGH 2021 IT’S NO SECRET THAT HEALTHCARE COSTS HAVE BEEN RISING FOR DECADES AND BY 2026 $1 IN EVERY $5 DOLLARS IN OUR ECONOMY WILL BE SPENT ON HEALTHCARE IN OTHER WORDS, THESE SAVINGS COULD NOT COME AT A BETTER TIME I WANT TO SINCERELY THANK ALL THE STAKEHOLDERS PROVIDING INVALUABLE INPUT, PARTICULARLY THE CLINICIANS ON THE FRONT LINES DAY IN AND DAY OUT BEFORE I CLOSE I WANT TO SAY WHILE I FOCUSED ON REGULATORY CHANGES TODAY THERE HAVE BEEN MANY IMPORTANT UPDATES AT THE SUB REGULATORY LEVEL AND PATIENTS OVER PAPERWORK INFORMS EVERYTHING WE DO AS HEALTHCARE PROVIDERS AND CLINICIANS YOU GUYS ARE THE EXPERTS YOU UNDERWENT EXTENSIVE SCHOOLING AND CAME INTO THIS PROFESSION TO CURE ILLNESSES AND SAVE LIVES NOT TO GET BOGGED DOWN IN NEVER ENDING MORASS OF PAPERWORK PORING OVER CONFUSING AND DUPLICATIVE FORMS WE ARE PROUD TO HAVE REDUCED THAT BURDEN AND GIVE YOU MORE

TIME WITH YOUR PATIENTS AND WE ARE DETERMINED TO KEEP THE BALL ROLLING THAT’S WHY WE HAVE GATHERED YOU ALL HERE TODAY WE PRACTICED TODAY’S LISTENING SESSIONS TO ALIGN WITH 16 INITIATIVES INFORMED BY OUR FIRST ROUND OF DISCUSSIONS WITH YOU WE HAVE DELIVERED ON THE CONCERNS THAT YOU VOICE THEN AND EAGER TO DO THE SAME FOR WHAT YOU TELL US TODAY WE ARE PARTICULARLY INTERESTED IN YOUR THOUGHTS ON RELAXING OVERLY BURDENSOME CONDITIONS OF PARTICIPATION, ADDRESSING RURAL HEALTH ISSUES AND TACKLING PRIOR AUTHORIZATION THAT LAST ONE, PRIOR AUTHORIZATION IS PARTICULARLY IMPORTANT TO US AND MORE BROADLY WE ARE DETERMINED TO EXPAND DRAMATICALLY OUR BURDEN REDUCTION EFFORTS ACROSS NOT JUST TRADITIONAL MEDICARE BUT ALL OUR OF OUR PROGRAMS IT’S SAFE TO SAY YOU WILL BE HEARING FROM CMS ON THESE ISSUES SO YOUR PERSPECTIVES DURING OUR BREAKOUT SESSIONS WILL SHAPE OUR APPROACH I WANT TO TURNOVER THE MICROPHONE TO OUR FIRST GUEST CONGRESSMAN BURGESS FOR SOME WORDS THANK YOU VERY MUCH [ APPLAUSE ] >> THANK YOU, ADMINISTRATOR VERMA IT’S ALWAYS A PLEASURE TO COME OVER AND JOIN YOU HERE AT THE CITADEL OF HEALTH POLICY MY CONGRESSIONAL OFFICE IS DIRECTLY ACROSS THE STREET IN FACT I CAN LOOK OUT MY WINDOW AND SEE THE HUBERT HUMPHREY BUILDING ANY TIME OF DAY OR NIGHT I WANT YOU TO KNOW I FEEL I HAVE DIRECT OVERSIGHT OVER THE SECRETARY OF HEALTH AND HUMAN SERVICES I JUST WANT TO SAY SECRETARY VERMA, I APPRECIATE YOUR WILLINGNESS TO ENGAGE WITH ME AND OTHER MEMBERS OF THE ENERGY AND COMMERCE COMMITTEE AND EVEN WAYS AND MEANS COMMITTEE OVER THE COURSE OF YOUR TENURE AT THE CENTER OF MEDICARE MEDICAID SERVICES HAVE YOU HAD AN OPEN DOOR POLICY THROUGH TWO SESSIONS OF CONGRESS I THINK THAT HAS SERVED, I KNOW IT HAS SERVED ME WELL AND I HOPE YOU FEEL THE SAME WAY LAST WEEK THE ENERGY AND COMMERCE COMMITTEE, THE SUBCOMMITTEE ON OVERSIGHT INVESTIGATIONS HELD A HEARING AND IT WAS LIVELY AND INTERACTIVE AND ADMINISTRATOR VERMA WAS ABLE TO SHARE WITH US SOME OF THE POSITIVE DEVELOPMENTS THAT THE CENTER FOR MEDICARE AND MEDICAID SERVICES HAS ACHIEVED THE LAST FEW YEARS YOU ARE ON YOUR SECOND ANNIVERSARY, THAT’S A GOOD THING N.2017 THEY LAUNCHED THE PAPER — PATIENTS OVER PAPERWORK INITIATIVE I’M THANKFUL FOR PUTTING OUT THE RECENT PROPOSED STARK LAW AND KICK BACK STATUTE REFORMS DR. BOUCHON AND I ARE PROBABLY THE ONLY ON CAPITOL HILL WHO UNDERSTOOD WHAT THAT MEANT BUT THEY WERE WRITTEN YEARS AGO TO REGULATE MEDICINE THAT NO LONGER EXISTS IN THIS COUNTRY IT’S GREAT NEWS FOR PATIENTS AND DOCTORS IT WILL ALLOW MORE PATIENT- CENTERED CARE, A STEP IN THE RIGHT DIRECTION TO ALLOW DOCTORS TO BE DOCTORS AS A PHYSICIAN I HAVE EXPERIENCED FIRSTHAND THE FRUSTRATION OF THE ELECTRONIC HEALTH RECORD, PRIOR AUTHORIZATION AND OTHER MECHANISMS THAT COULD STAND BETWEEN A DOCTOR PROVIDING THE BEST CARE FOR THEIR PATIENT I’M GLAD CMS HAS TAKEN ON SOME OF THESE ISSUES TO ALLEVIATE AND REMOVE SOME HURDLES WE HAVE TO JUMP I APPRECIATE THE ADMINISTRATOR’S COMMITMENT TO ADDRESS PRIOR AUTHORIZATION AT OUR HEARING LAST WEEK DOCTORS SHOULD BE MAKING CLINICAL CONDITIONS BASED ON WHAT IS BEST FOR THEIR PATIENT AND NOT BE PREVENTED FROM MAKING THAT THOSE DECISIONS BY A THIRD PARTY THANK YOU FOR THE HEARING I HOPE IT WAS AS USEFUL TO YOU AS US NOW I WOULD LIKE TO TURN THIS MICROPHONE OVER TO ANOTHER VALUABLE MEMBER OF THE HEALTH SUBCOMMITTEE ON COMMITTEE OF ENERGY AND COMMERCE, DR. LARRY BOUCHON WHO WAS THE PRESIDENT OF THE UNITED STATES THE LAST TIME THERE WAS A PHYSICIAN AS CHAIR OF THE ENERGY AND COMMERCE COMMITTEE? IT WAS ANDREW JACKSON SO IT’S BEEN A LONG TIME >> THANK YOU VERY MUCH I WANT TO ASSOCIATE MYSELF WITH ALL THE COMMENTS DR. BURGESS JUST MADE HE REALLY OUTLINED THE SITUATION BUT I’M HERE, I REALLY WANT TO THANK ADMINISTRATOR VERMA AND HER TEAM FOR WHAT THEY ARE DOING THIS IS A TREMENDOUS INITIATIVE AND I WILL GO OVER WHY THIS IS IMPORTANT SOME OF THE THINGS DR. BURGESS

SAID BUT I WILL TOUCH ON SOME LIFESTYLE ISSUES FOR PHYSICIANS WHAT I’M HEARING IN MY HOMETOWN I ALSO WANT TO THANK ADMINISTRATOR VERMA AND HER TEAM FOR HER ACCESSIBILITY AND OPENNESS AND WILLINGNESS TO LISTEN AND LISTEN TO PEOPLE WHO ARE OUT THERE EVERYDAY TRYING TO TAKE CARE OF PATIENTS AND HONESTLY THEY ARE VERY RESPONSIVE TO CONCERNS AND QUESTIONS THAT PRACTICING PHYSICIANS HAVE EVERYDAY IN REAL LIFE, THIS IS ONE OF THE BIGGEST ISSUES I HEAR ABOUT FROM MY PHYSICIAN FRIENDS WHEN I GO BACK WHEN I SEE THEM AT RESTAURANTS, THEY SAY I’M SPENDING MORE TIME LOOKING AT A COMPUTER SCREEN THAN TAKING CARE OF PATIENTS I REALLY CAN’T OVERESTIMATE THE IMPORTANCE OF THIS TO THE QUALITY OF LIFE I MEAN PEOPLE ARE MAKING DECISIONS TO LEAVE MEDICINE, AS EVERYONE KNOWS, EARLY IN THEIR CAREER AND WE ARE LOSING QUALITY PEOPLE WE ARE ALSO HAVING MORE DIFFICULTY TIME RECRUITING PHYSICIANS INTO CERTAIN SPECIALTIES, CERTAIN AREAS THAT ARE MORE BURDENSOME AND DIFFICULT TO MANAGE FROM AN ADMINISTRATIVE STANDPOINT SO THIS HAS REAL LIFE IMPACT ON OUR ABILITY TO TAKE CARE OF PEOPLE HAVE I PHYSICIANS TELL ME THE YOUNGER DOCTORS WHEN THEY COME HOME, ONCE THE KIDS ARE IN BED THEY GO BACK TO THEIR COMPUTER SCREEN AND FINISH THEIR DAY’S WORK, THEY MAY SPEND AN HOUR OR TWO IN THE EVENING FINISHING THE WORK THEY DID DURING THE DAY THIS IS A SUBSTANTIAL QUALITY OF LIFE ISSUE WHICH IS VERY FRUSTRATING I VERY MUCH APPRECIATE WHAT IS BEING DONE AND WHAT CONTINUES TO BE DONE IN THIS AREA A COUPLE THINGS DR. BURGESS TOUCHED ON WITH THE STARK LAW IS VERY IMPORTANT THANK YOU VERY MUCH FOR TRYING TO ADDRESS THAT AND CONTINUING TO WORK ON ELECTRONIC HEALTH RECORD EFFICIENCIES AND TRYING TO A MORE INTEROPERABLE SYSTEM THAT WORKS FOR EVERYONE THIS IS ANOTHER CRITICAL ISSUE THAT FRUSTRATES PROVIDERS, ESPECIALLY IN COMMUNITIES LIKE MINE WHO HAVE TWO HOSPITAL SYSTEMS WITH TWO HEALTH RECORD SYSTEMS BUT THE DOCTORS GO TO BOTH HOSPITALS AND IT’S CONFUSING AND PATIENTS GO TO BOTH HOSPITALS MANY TIMES SO THANK YOU FOR THAT WORK THAT IS ONGOING BUT AGAIN, AS A PRACTICING PHYSICIAN, THIS INITIATIVE WHEN IT CAME OUT A COUPLE YEARS AGO I REALLY FELT WAS ONE OF THE MOST IMPORTANT THINGS WE COULD TRY TO ADDRESS FOR OUR HEALTHCARE SYSTEM THE LAST THING I WANT TO TOUCH ON IS THE COST TO THE SYSTEM OF BURDENSOME ADMINISTRATIVE HURDLES THE COST OF THAT ARE GOING UP AND HAVE GONE UP AND SO AGAIN, NOT ONLY IS THIS ABOUT PHYSICIAN LIFESTYLE AND ABOUT TAKING CARE OF PATIENTS, THIS IS LEGITIMATELY ABOUT HOW DO WE PAY FOR A HEALTHCARE SYSTEM GOING INTO THE FUTURE HOW DO WE MAKE SURE ALL OF US HAVE ACCESS TO QUALITY AFFORDABLE HEALTHCARE, IF WE DON’T ADDRESS THE ADMINISTRATIVE BURDEN IN AN AGGRESSIVE WAY WE WILL HAVE MORE AND MORE CHALLENGES IN THAT AREA WITH THAT, THANK YOU VERY MUCH, ADMINISTRATOR VERMA AND YOUR TEAM FOR ALL YOU ARE DOING AND AGAIN, THANK YOU FOR THE OPENNESS AND THE OPEN DOOR POLICY THAT YOU HAVE AND FOR LISTENING TO PROVIDERS OUT THERE WHO ARE EVERYDAY WAKING UP, JUST TRYING TO FIGURE OUT THE BEST WAY TO TAKE CARE OF PATIENTS THANK YOU >> ALL RIGHT UP NEXT WE WILL HEAR FROM THREE CLINICIANS THEY ARE DR. RYAN WHISTLER, CLINICAL COORDINATOR, JOHNS HOPKINS, RODGER WELLS PHYSICIAN ASSISTANT LEXINGTON NEBRASKA REGIONAL HEALTH CENTER AND DR STEWART BEADY, PharmD ASSOCIATE PROFESSOR DR. WHISTLER, WILL YOU PLEASE COME UP? IF YOU WOULD JUST FOLLOW ONE AFTER ANOTHER, THAT WOULD BE GREAT >> THANK YOU ADMINISTRATOR VERMA AND THE TEAM FOR INVITING ME TO SPEAK ABOUT MY EXPERIENCE AS A MEMBER OF THE HEALTHCARE COMMUNITY WE KNOW LACK OF ACCESS TO PRESCRIBED MEDICATION CAN BE A SIGNIFICANT BARRIER FOR OUR PATIENTS IN MAINTAINING THEIR HEALTH IN TRANSPLANT RECIPIENTS THE PATIENT POPULATION I WORK WITH, WE KNOW ANY MISDOSE CAN INCREASE THE LIKELIHOOD OF ORGAN DONOR AND NEED FOR TRANSPLANTATION

WHILE REPORTED RATES VARY A JOURNAL PUBLISHED FOUND UP TO A THIRD OF PRESCRIPTIONS IN THE EMERGENCY ROOM GO UNFILLED BEDSIDE DELIVERY PROGRAMS HAVE BEEN RECOGNIZED AS A PREFERRED METHOD THUS LOWERING THE LIKELIHOOD OF MISSED DOSES I MENTIONED A MOMENT AGO AT THE JOHNS HOPKINS OUTPATIENT PHARMACIES, TEAMS DELIVER TO ALL PATIENTS RECEIVING AN ORGAN TRANSPLANT WITH PURPOSE, SIDE EFFECTS DOSING SCHEDULE AND SPECIAL ADMINISTRATION INSTRUCTIONS AND ASSIST IN SETTING UP A PILL BOX WHICH FACILITATES ADHERENCE, CONSISTING OF MULTIPLE TABLETS AND PILLS AT EACH DOSING TIME THROUGHOUT THE DAY PRIOR TO THE REGULATION CHANGE PART OF THE PATIENTS OVER PAPERWORK EFFORTS OUR SERVICE WAS NOT ABLE TO PROVIDE ANTI REJECTION MEDICATIONS AS PART OF THE DISCHARGE PROCESS CMS REGULATIONS RESTRICTED THIS TO ADDRESS ON FILE WITH MEDICARE W. THIS CHANGE WE ARE NOW ABLE TO INCLUDE THESE ANTI REJECTION MEDICATIONS AS PART OF THE PROCESS THERE BY ENSURING IMMEDIATE ACCESS TO THESE CRITICAL MEDICATIONS AFTER DISCHARGE AS MY TEAM MEETS WITH PATIENTS IN PREPARATION WITH DISCHARGE TO EDUCATE ABOUT THE NEW MEDICATION REGIMENS WE CONTINUE TO HEAR HOW THANKFUL THEY ARE TO HAVE MEDICATIONS IN HAND, IN A PILL BOX AS THEY LEAVE THE HOSPITAL JUST EARLIER THIS MONTH I WAS IN A HOSPITAL ROOM OF A PATIENT WHOSE HOME WAS SEVERAL HOURS AWAY FROM JOHNS HOPKINS SHE TOOK TIME TO THANK ME FOR PROVIDING HER MEDICATIONS AS SHE WENT THROUGH THE FINAL STEPS OF PREPARING FOR DISCHARGE SHE TOLD ME I DON’T KNOW HOW I COULD HAVE HANDLED GOING TO A PHARMACY AND FULFILLING THESE MEDICATIONS THIS EVENING AFTER ALL I HAVE BEEN THROUGH AND ALL I HAVE TO STILL DO ONCE I LEAVE THANK YOU FOR MAKING SURE I HAVE ALL MY MEDICATIONS THIS IS ONE LESS THING I HAVE TO WORRY ABOUT I KNOW SHE DIDN’T KNOW IT BUT PATIENTS OVER PAPERWORK MADE THIS POSSIBLE FOR HER AND HUNDREDS OF OTHER PATIENTS AND WILL CONTINUE TO DO SO FOR THOUSANDS OF OTHER TRANSPLANT RECIPIENTS THANK YOU [ APPLAUSE ] >> GOOD MORNING, MY NAME IS RODGER WELLS, I’M A PHYSICIAN IN LEXINGTON NEBRASKA, A REAL COMMUNITY WITH HEALTH CLINIC I HAVE HAD THE HONOR OF WORKING IN RURAL HEALTHCARE FOR 30 YEARS AND I WOULD LIKE TO GIVE YOU A PERSPECTIVE WHAT OUR JOB IS I STARTED WORKING IN AN ERA WHERE THERE WAS TREMENDOUS FREEDOM PROVIDERS LOVED THEIR WORK, THEY HAD EMPATHY AND PERSONAL GIVING FOR APPROPRIATE CARE TO PATIENTS IN THEIR COMMUNITY DURING MY CAREER I HAVE SEEN A DRAMATIC CHANGE CHANGE IN THE DELIVERY OF MEDICAL CARE STARTED WITH NO ALGORITHMS, NO PRACTICE GUIDELINES, NO PREAUTHORIZATION, MINIMAL DOCUMENTATION TO BURDENSOME GRIND SOME ESTIMATE 47% WORKDAY OF ADMINISTRATIVE TIME INSTEAD OF CARING FOR PATIENTS IN RURAL AMERICA THE BURDEN IS MORE CONCERNING BECAUSE THE EXODUS OF PROVIDER PRESENCE FROM THE RURAL HEALTHCARE IN THE FUTURE IS EXPECTED TO BE WORSE JUST DUE TO BURN OUT THERE’S ALREADY BEEN 118 SMALL HOSPITALS CLOSED AND 388 CLOSURES, PRESENTLY ABOUT 18% OF THE U.S. POPULATION RESIDES IN RURAL AMERICA BUT ABOUT 10% OF PHYSICIANS PRACTICE IN RURAL AMERICA AND IT’S MUCH DIFFERENT THAN AN URBAN ENVIRONMENT RURAL BENEFICIARIES ARE GENERALLY OLDER, SICKER, HAVE MORE CO MORBIDITY, LOWER SOCIOECONOMIC, HIGHER MENTAL HEALTH ISSUES, DISEASE AND DRUG ABUSE LESS ADMINISTRATIVE SUPPORT, THE COMMUNITY IS BASED MORE ON ZIP CODE THAN HEALTHCARE PROVIDER ABILITY

RECENTLY ONE DAY WHILE WORKING IN OUR LOCAL EMERGENCY DEPARTMENT I SAW THIS A FALL WITH LOSS OF CONSCIOUSNESS AND FRACTURES, A MISCARRIAGE IN PREGNANCY AND GAL BLADDER REQUIRING TRANSFER BECAUSE WE DIDN’T HAVE A SURGEON THEY HAD TO BE REMOVED A PATIENT IN RESPIRATORY FAILURE NEEDED TRANSFER TO SPECIALIST ACUTE APPENDICITIS IN A 3-YEAR- OLD THAT NEED TODAY BE TRANSFERRED BECAUSE WE DIDN’T HAVE A SURGEON CONSULTATION FOR MANY OTHERS IN ONE DAY THESE CASES REQUIRE MENTAL HEALTH RECORD INTEROPERABILITY, PATIENT DATA INFORMATION, BY USING TOOLS THEY ARE TREATED BY THE APPROPRIATE PROVIDER WITH THE APPROPRIATE LEVEL OF CARE, AT THE APPROPRIATE TIME NOW WITH THE CHANGES DUE TO THE CMS PATIENTS OVER PAPERWORK PROGRAM WE ARE EXPERIENCING IMPROVEMENTS IN THE HEALTHCARE DELIVERY MODELS IN MANY RURAL SETTINGS LET’S SEE HOW IN RURAL NEBRASKA WE SEE TRAUMA CARE ASSISTANCE IN THE EMERGENCY, INPATIENT TO REDUCE PROVIDER CALL BURDEN, SPECIALTY CONSULTS, ACUTE HEART ATTACKS CONGESTIVE HEART FAILURE AND PREMATURE DELIVERY OF A 28 WEEK MOTHER WE SEE RANGING FROM DERMATOLOGY TO PULMONARY THEY ARE ADOPTING NEW EVALUATION AND MANAGEMENT CODES BECAUSE OF LACK OF TECHNICAL SUPPORT AND FINANCES BUT CMS MODIFIED WITH BONUS POINTS SUCH AS FOUND IN QUALITY PERFORMANCE CATEGORY SCORERS RURAL OUT CLINICS NOW, IF THEY HAVE AN APPROPRIATE RELATIONSHIP WITH THE HOSPITAL CAN SUBMIT MIXED SCORING THIS IS NECESSARY TO ENTICE THE PRACTICES, TO REDIRECT FINANCIAL RESOURCES THESE BENEFITS ALLOW PROVIDERS TO REFOCUS THEIR RESOURCES AND DEVELOP PRACTICE MODELS FOR BETTER OUTCOMES IN CLOSING, I BELIEVE THE PATIENT EXPERIENCE, THE PATIENT OUT COMES, THE PROVIDER LOSS, THE SOCIAL DETERMINANTS OF HEALTHCARE ALL HAVE A BETTER PROGNOSIS WITH THE NEW HUMAN CENTERED DESIGN AND MODIFICATION AND IMPLEMENTATION WITH THE CMS PATIENTS OVER PAPERWORK PROGRAM WE LOOK FOR THE OPPORTUNITY TO PRACTICE MEDICINE IN RURAL AMERICA THANK YOU VERY MUCH [ APPLAUSE ] >> MY NAME IS STEWART BADY I WANT TO THANK YOU FOR ALLOWING ME TO BE HERE REPRESENTING PHARMACISTS FOR THE PATIENTS OVER PAPERWORK INITIATIVE PHARMACISTS SHARE AND APPRECIATE CMS’S GOAL TO REDUCE BURDEN TO PROVIDE PATIENT CENTER CARE, INNOVATIONS AND OUT COMES I HAVE PRACTICED AS A PHARMACIST WITHIN OHIO STATE UNIVERSITY OUR SEVEN PRIMARY CLINICS INCLUDE A ROBUST TEAM OF HEALTHCARE PROFESSIONALS WORKING TOGETHER TO CARE FOR OVER 70,000 PATIENTS IN CENTRAL OHIO CMS LED PRIMARY PLUS INITIATIVE OUR CLINICIANS IN LEADERSHIP BELIEVE STRONGLY IN THE VALUE OF PHARMACISTS AND THIS HAS ALLOWED US TO EMBED A PHARMACIST IN EACH OF OUR SEVEN PRACTICE SITES THE ROLE IS TO FOCUS ON THE HIGHEST RISK PATIENTS AS THEY TEND TO BE ON THE HIGHEST RISK MEDICATIONS PHARMACISTS HAVE ROLES IN TRANSITIONAL MANAGEMENT CARING FOR COMPLEX PATIENTS, UNCONTROLLED DIABETES, HYPERTENSION AND BEHAVIORAL HEALTH ISSUES I WILL BRIEFLY DISCUSS TWO PATIENT ENCOUNTERS THE FIRST IS A 70-YEAR-OLD MALE STRUGGLING TO REDUCE HIS DIABETES I REVIEWED HIS CHART FOR KEY ELEMENTS OF HIS MEDICAL HISTORY AND CLARIFIED HE HAD DIABETES FOR 15 YEARS, EATS A STANDARD MEDITERRANEAN DIET AND SUFFERS

FROM KNEE PAIN HIS PORTIONS ARE LARGER THAN THEY SHOULD BE AND OFTEN DOESN’T TAKE DIABETES MEDICATION DUE TO COST ISSUES I SPENT MORE THAN 75% OF MY TIME DEVELOPING A PLAN FOR THIS PATIENT INCLUDING HOW TO NAVIGATE RAMADAN WITH DIABETES IN NINE MONTHS, I HIGHLIGHT ONLY ONE OFFICE VISIT WITH THE PHYSICIAN, IT’S GO FROM 12.5% TO 8.3% A SIGNIFICANT DROP BECAUSE THE PHARMACIST HAS BEEN ALLOWED TO BE INVOLVED IN THAT CARE LET ME ALSO MENTION A 56-YEAR- OLD AFRICAN AMERICAN FEMALE ON MEDICARE FOR LONG TERM DISABILITY IDENTIFIED ON CHRONIC DOSES OF OPIOIDS AND REFERRED FOR A NALOXONE TRAINING SESSION ALSO DIAGNOSED WITH DEPRESSION AND ANXIETY, STARTED ON MEDICATION AND REFERRED TO EMBEDDED SOCIAL WORKER FOR COUNSELING I VISITED AT THE END OF THE FIRST COUNSELING SESSION AND ABLE TO EDUCATE ON THE APPROPRIATE USE OF NALOXONE, SHE WAS RECEIVING PARTIAL RESPONSE AND ABLE TO TITRATE TO A HIGHER DOSE THIS HAPPENED OUTSIDE A STANDARD OFFICE VISIT ALLOWING HER PRIMARY CARE PROVIDER TO CREATE ACCESS FOR OTHER PATIENTS I WAS ABLE TO ACCOMPLISH MY PORTION OF THIS VISIT IN LESS THAN TEN MINUTES BECAUSE I DIDN’T NEED TO FOCUS ON REGATHERING HISTORY PREVIOUSLY OBTAINED IN THE CHART I CAN SHARE MANY INSTANCES WHEN I SPEAK AT CONFERENCES AROUND THE COUNTRY THE ISSUE HASN’T BEEN ON WHAT PHARMACISTS CAN DO TO HELP BUT HOW CAN PRACTICES FIND A WAY TO RESOURCE THEIR INVOLVEMENT I ENCOURAGE CMS TO FACILITATE SUSTAINABLE MECHANISMS FOR PHARMACISTS AND TEAM BASED MODELS I CAN’T THANK CMS ENOUGH FOR ALLOWING OUR TEAM TO REDUCE ADMINISTRATIVE BURDENS THANK YOU FOR YOUR TIME >> OUR NEXT TWO SPEAKERS, DR BARBARA LEVY THE SECOND IS DR. JANICE ORLOWSKI AT DOUBLE A.M.C >> THANK YOU SO MUCH FOR THE INVITATION IT’S A GREAT PLEASURE TO BE WITH YOU MY NAME IS BARBARA LEVY, OBSTETRICIAN GYNECOLOGIST AND CO-CHAIR OF A.M.A. C.P.T. RUCK EVALUATION MANAGEMENT WORK GROUP THAT WAS CONVENED TO TRY TO HELP US FIGURE OUT A BETTER WAY TO DOCUMENT THAT REDUCE THE BURDEN I’M HERE ON BEHALF OF THE MEDICAL ASSOCIATION AND WE ARE REALLY THRILLED TO BE PARTNERS WITH CMS IN FORWARDING THIS TO REDUCE BURDEN ON PROVIDERS FOR EVERY HOUR WE SPENT, WE SPEND TWO HOURS IN ADMINISTRATIVE WORK AND WE DIDN’T GO TO MEDICAL SCHOOL TO DO PAPERWORK MOST OF US, I WOULD VENTURE TO SAY ALL OF US WENT TO MEDICAL SCHOOL TO TAKE CARE OF PATIENTS THEY NEED AND DESERVE MORE OF OUR TIME, OF OUR EFFORT, OF OUR ENERGY AND THESE INITIATIVES ARE WELL POSITIONED TO HELP US DO THAT WE NEED TO BE FREED OF THE EXCESSIVE ADMINISTRATIVE BURDENS TO DEVOTE THAT TIME TO PATIENT CARE THAT’S WHY THE A.M.A. ADVOCACY WORK IS FOCUSED ON REMOVING OBSTACLES THAT OFTEN INTERFERE WITH TAKING CARE OF PATIENTS BECAUSE OF THIS WORK, THEY STRONGLY SUPPORT ADMINISTRATOR VERMA, THANK YOU, AND THE PATIENTS OVER PAPERWORK INITIATIVE AS CO-CHAIR OF THIS WORK GROUP ON MANAGEMENT CODING AND SERVICES, THAT’S A DIRECT RESULT OF THE PATIENTS OVER PAPERWORK INITIATIVE AND WE ARE SO GRATEFUL FOR THAT OPPORTUNITY WE HAVE ENGAGED WITH ADMINISTRATOR VERMA’S STAFF THROUGHOUT THE PROCESS AND IT’S BEEN A GREAT COLLABORATION FOR YEARS THE PHYSICIAN COMMUNITY HAS STRUGGLED WITH BURDENSOME GUIDELINES FOR REPORTING AND EVALUATION

MANAGEMENT SERVICES IN 2018 UNDER VERMA’S LEADERSHIP, CMS PROVIDED OPPORTUNITY TO ACHIEVE REAL BURDEN RELIEF FOR AMERICAN PHYSICIANS AND WE CAN SPEND MORE TIME CARING FOR OUR PATIENTS KNOWING ADMINISTRATOR VERMA’S COMMITMENT TO ADDRESSING THIS CRITICAL ISSUE IN AUGUST 2018 THE LEADERSHIP OF THE EDITORIAL PANEL AND SPECIALTY SOCIETY R.D.S. COMMITTEE, THAT’S REALLY A MOUTHFUL CONVENES IT’S WORK GROUP TO CREATE NEW STRUCTURE FOR EVALUATION AND MANAGEMENT SERVICES OVER THE COURSE OF THE NEXT SEVERAL MONTHS THE WORK GROUP CONVENED EIGHT OPEN STAKEHOLDER CALLS OR MEETINGS WHERE ON AVERAGE NEARLY 300 INDIVIDUALS PARTICIPATED AND CMS STAFF PARTICIPATED IN EVERYONE OF THOSE CALLS AND MEETINGS IN BETWEEN THE CALLS AND MEETINGS THE WORK GROUP CONDUCTED FIVE SURVEYS DESIGNED TO COLLECT TARGETED FEEDBACK FROM ALL INTERESTED PARTIES AND IT WAS REALLY DUE TO ADMINISTRATOR VERMA’S COMMITMENT TO THIS AND HER DETERMINATION THAT WE GOT THE ATTENTION AND INVOLVEMENT FROM ALL STAKEHOLDERS MEDICAL SOCIETIES AND PAYERS AND THROUGHOUT THE PROCESS WE KEPT CMS INFORMED OF THE DEVELOPMENTS THE NEW FRAMEWORK WHICH HAS BEEN CRAFTED PROVIDES PHYSICIANS WITH EASIER OPTIONS WE CAN REPORT EITHER BASED ON TOTAL TIME WITH PATIENTS OR BASED ON THE CARE THAT WE ARE DELIVERING ON THE MEDICAL DECISION MAKING THAT GOES INTO TAKING CARE OF PATIENTS AND WE NO LONGER HAVE TO CHECK BOXES AND TALK ABOUT NUMEROUS CUMBERSOME DOCUMENTATION CASES THAT WE NEED TO DO SO ULTIMATELY AFTER A GREAT DEAL OF WORK AND EFFORT AND COLLABORATION THE CPT EDITORIAL PANEL ADOPTED THE WORK GROUP’S RECOMMENDATIONS TO IMPLEMENT A NEW FRAMEWORK FOR SELECTING AND DOCUMENTING EVALUATION AND MANAGEMENT OFFICE VISITS THE WORK THEN MOVED TO THE R.B.F. UPDATE COMMITTEE WHICH ULTIMATELY SENT RECOMMENDATIONS TO CMS FOR EVALUATION OF MAY OF 2018 THESE RECOMMENDATIONS RECOGNIZED PRIMARY CARE AND ALL PHYSICIANS WHO PROVIDE CARE TO PATIENTS IN THE OFFICE SETTING WE AREN’T CERTAIN ABOUT THE FINAL OUTCOME OR WHAT THE FINAL POLICY WILL BE BUT HOWEVER WE ARE REALLY HOPEFUL THAT CMS WILL FULLY IMPLEMENT THE C.P.P RUCK WORK PRODUCT IN 2021 THE AMA IS CONFIDENT THIS NEW OFFICE VISIT REPORTING FRAMEWORK WILL LESSEN THE DOCUMENTATION BURDEN FOR PROVIDERS AND ALLOW THEM TO SPEND MORE TIME WITH THEIR PATIENTS I WANT TO THANK ADMINISTRATOR VERMA AN THE PATIENTS OVER PAPERWORK INITIATIVE FOR THE COMMITMENT TO REDUCING THIS BURDEN THANK YOU >> GOOD MORNING I’M JANICE, THE CHIEF HEALTHCARE OFFICER I’M A PRACTICING NEPHROLOGIST GIST ON BEHALF OF OUR 154 ACCREDITED U.S. MEDICAL SCHOOLS NEARLY 400 MAJOR TEACHING HOSPITALS AND HEALTH SYSTEMS, OUR FACULTY RESIDENTS AND STUDENTS, I THANK YOU FOR THE OPPORTUNITIES TO SPEAK ON THE IMPORTANT ISSUE OF REDUCING REGULATORY BURDEN THE A.A.M.C. STRONGLY SUPPORTS ADMINISTRATOR VERMA AND CMS’S PATIENTS OVER PAPERWORK INITIATIVE WHICH STRESSES THE IMPORTANCE OF REDUCING BURDENS TO ALLOW PHYSICIANS HOSPITALS AND OTHER HEALTHCARE PROFESSIONALS TO DEVOTE MORE TIME TO PATIENT CARE AND APPRECIATE CMS’S COMMITMENT BY FOCUSING ON PATIENT CENTERED CARE SPECIFICALLY CMS HAS ALREADY PROVIDED SOME SIGNIFICANT REGULATORY RELIEF TO HOSPITALS AND PHYSICIANS, I JUST WANT TO NOTE A FEW THE A.A.M.C. APPRECIATES THE REVISION TO THE MANUAL INSTRUCTIONS TO ALLOW TEACHING PHYSICIANS TO VERIFY IN THE MEDICAL RECORDS ANY STUDENT DOCUMENTATION OF BILLABLE SERVICES RATHER THAN REQUIRING THE ATTENDING PHYSICIANS TO REDOCUMENT THE WORK THOUGH WE HAVE TALKED ABOUT THE PHYSICIANS WORK BEING REDUCED WITH THIS IF YOU HAVE EVER READ ELECTRONIC HEALTH RECORD IT’S

NEARLY IMPOSSIBLE WITH ALL THE REDOCUMENTATION, SO THESE REALLY MAKE THE PATIENT RECORD EASIER TO FOLLOW AND THEREFORE PATIENT CARE BETTER AND APPRECIATES CHANGES AFFECTED IN 2019 THAT REDUCED BURDEN ON TEACHING PHYSICIANS BY STATING THAT THE PRESENCE OF THE TEACHING PHYSICIAN DURING PROCEDURES AND E.M.N. SERVICES MAY BE DEMONSTRATED BY THE NOTES IN THE MEDICAL RECORDS EITHER BY PHYSICIAN, RESIDENTS OR NURSE IN ADDITION THE PROPOSAL IN 2020 TO INCLUDE MEDICAL STUDENTS AND OTHERS WHILE WE ARE PLEASED WITH THESE REFINEMENTS WE ALSO BELIEVE THERE ARE ADDITIONAL CHANGES THAT COULD BE MADE TO REDUCE BURDEN FOR TEACHING PHYSICIANS IN THE FUTURE AND WE PROMISE TO WORK WITH C.M.S. TO REVISIT THE TEACHING REGULATIONS AND GUIDELINES ESTABLISHED IN 1995, MORE THAN 20 YEARS AGO SO IT’S TIME FOR US TO CHANGE THESE SO THAT THEY REFLECT THE WORK THAT WE DO TODAY AND THE WORK THAT WE DO IN TEAMS CMS ALSO IMPLEMENTED TWO SIGNIFICANT DOCUMENTATION CHANGES IN 2019 WE BELIEVE WILL LEAD TO IMPROVED PATIENT CARE AND BETTER ALIGN WITH CURRENT MEDICAL PRACTICE AND USE OF THE ELECTRONIC HEALTH RECORD INCLUDE REQUIRING PHYSICIAN TO FOCUS DOCUMENTATION ONLY ON WHAT HAS CHANGED SINCE THE LAST VISIT RATHER THAN REDOCUMENTING A WHOLE SERIES REQUIRED ELEMENT AND IN ADDITION TO THE PHYSICIAN DOES NOT NEED TO REDOCUMENT CHIEF COMPLAINT ILLNESS ALREADY DOCUMENTED IN THE MEDICAL RECORD BY OTHER CLINICAL PROVIDERS THESE CHANGES ALLOW PHYSICIANS TO EXERCISE THEIR CLINICAL JUDGMENT AND DISCRETION TO DOCUMENT WHAT IS CLINICALLY RELEVANT AND MEDICALLY NECESSARY FOR THE CARE OF THE PATIENT IN THE PROPOSED 2020 FEE SCHEDULE RULES CMS PROPOSES CHANGES TO CODING, DOCUMENTATION AND CODING EFFECTIVE IN 2021 WE ALSO SUPPORT FINALIZING THE POLICY FOR 2021 ALLOWING PHYSICIANS TO DOCUMENT BASED ON MEDICAL DECISION MAKING OR TIME WOULD HELP ALLEVIATE PROBLEMS OF DOCUMENTATION LEAD TO IMPROVED PATIENT CARE AND CURRENTLY ALIGN WITH PRACTICES AND CURRENT USE OF THE ELECTRONIC MEDICAL RECORD WE APPLAUD CMS FOR ITS EFFORTS TO REDUCE REGULATORY BURDEN AND WE BELIEVE THERE’S MORE WE CAN DO TO CHANGE THAT WOULD HELP TO REDUCE THE BURDEN WE ARE LOOKING AT WAYS TO CONTINUE DOCUMENT OR ADJUSTING THE DOCUMENTATION FOR SOCIAL DEMOGRAPHIC FACTORS, PAYMENT INEQUALITY PROGRAMS REDUCE BARRIERS TO TELEHEALTH AND REDUCING COMPLEXITY AND ALIGN THE MULTIPAYMENT PROGRAMS ACROSS PAYERS WE CONTINUE TO WELCOME THE OPPORTUNITY TO WORK WITH CMS ON FUTURE INITIATIVES ON BURDEN REDUCTION AND WE THANK YOU FOR THE WORK YOU HAVE ALREADY DONE [ APPLAUSE ] >> I WOULD LIKE TO THANK ALL THE SPEAKERS TODAY IF WE COULD GIVE ANOTHER ROUND OF APPLAUSE, THAT WOULD BE FANTASTIC IT’S SO GREAT TO HEAR PATIENTS OVER PAPERWORK HAS ALREADY HAD POSITIVE EFFECT ON THE MEDICAL COMMUNITY THANK YOU AND THANK MANY OF THE OTHERS IN THE AUDIENCE WHO HAVE CONTRIBUTED IN SOME WAY TO INFORMING THE WORK WE ARE DOING WHEN WE STARTED PATIENTS OVER PAPERWORK WE REALIZED CMS NEEDED TO CHANGE THE WAY WE OPERATED TO ESTABLISH THE PROGRAM EFFECTIVELY THERE’S THREE THINGS WE HAD TO DO IN PARTICULAR WE HAD TO COLLABORATE ACROSS THE AGENCY AND COMPONENTS AND MORE SO ACROSS THE PROGRAMS TO MAKE SURE WE ARE PRIORITIZING THE BURDEN ISSUES WE SHOULD BE FOCUSING ON AND MAKE SURE ONE PART OF CMS IS NOT DECREASING BURDEN AND INCREASING BURDEN FOR ANOTHER PART OF THE PROGRAM AT THE EXACT SAME TIME, WE DO THIS BY ESTABLISHING A STEERING COMMITTEE, MADE OF CMS EXECUTIVES TO DO JUST THAT TO HEAR AND UNDERSTAND THE INPUT WE RECEIVE FROM THE EXTERNAL COMMUNITY FIGURING OUT WHAT WE CAN DO AND WORKING TOGETHER TO MAKE SURE WE ARE CONSISTENT IN OUR APPROACH AS WE ADDRESSING THE BURDENS THE SECOND WHICH IS ABSOLUTELY

CRITICAL TO GET THIS RIGHT IS TO HEAR FROM THE MEDICAL COMMUNITY IT WOULD BE GREAT TO TALK TO EACH OTHER ABOUT WHAT WE UNDERSTAND ABOUT BURDENS IN THE EXTERNAL COMMUNITY AND WHAT WE CAN DO ABOUT THEM BUT IT’S ABSOLUTELY CRITICAL TO TALK TO FOLKS IN THE MEDICAL FACILITIES, CLINICAL PRACTICES, IN THE HEALTH PLANS FOR THAT MATTER OR OTHER HEALTHCARE STAKEHOLDERS TO UNDERSTAND HOW OUR RULES IMPACT THEIR DAY-TO- DAY OPERATIONS WHETHER IT’S MAKING THEM BETTER WE GET SOME INPUT ON THAT SOMETIMES TOO BUT REALLY, HOW IT’S IMPEDING GOOD CARE DELIVERY OR MAYBE EVEN INNOVATION SO EXTERNAL INPUT IS CRITICAL ADMINISTRATOR VERMA MENTIONED WE GET STAKEHOLDER INPUT IN A VARIETY OF WAYS TO REQUEST MORE INFORMATION, LISTENING SESSIONS AND INTERVIEWS BUT THE MOST CRITICAL THING IS GETTING CMS STAFF OUT OF OUR BUILDINGS AND INTO PROVIDER FACILITIES AND CLINICAL PRACTICES AND OBSERVE FROM AND TALK WITH FRONT LINE STAFF TO UNDERSTAND WHERE THE CHALLENGES REALLY ARE WE KNOW FOR EXAMPLE THAT IT’S HARD TO FIND SOME OF OUR DOCUMENTATION REQUIREMENTS SO IT’S NOT ALWAYS CLEAR EXACTLY WHO TO CALL AND WHEN TO CALL, WE KNOW THAT BUT WHEN YOU SIT NEXT TO AN ADMINISTRATIVE STAFF PERSON WHO HAS 40 STICKIES AROUND THEIR COMPUTER THAT IS A LINK TO NOT JUST OUR RESOURCES BUT THE RESOURCES OF THE OTHER HEALTH PLANS THEY HAVE TO INTERACT WITH AS WELL THAT HAS A DIFFERENT KIND OF IMPACT AND IF A EMPHASIZES WHAT IS REALLY IMPORTANT IT FEELS LIKE SOMETHING WE CAN CHANGE WE HAVE OUR GOAL NEXT YEAR IS TO GET AT LEAST 2000 MORE STAKEHOLDERS INVOLVED IN PROVIDING US INPUT LAST YEAR PROBABLY 3,000 WE ALSO HAVE SEVERAL HUNDRED CMS STAFF INVOLVED AND WE WANT TO DOUBLE OR EVEN TRIPLE THAT NEXT YEAR TO GET THEM OUT THERE AND TALK TO PEOPLE DIRECTLY SO TO GIVE YOU A FLAVOR FOR THE EXPERIENCE OF THE CMS STAFF WE WILL SHOW YOU A BRIEF VIDEOTAPE AND WE HAVE SHEILA BLACKSTOCK WHO WILL TALK TO YOU DIRECTLY ABOUT HER EXPERIENCE [ VIDEO ] >> I’M SHEILA BLACKSTOCK FOR THOSE WHO DON’T KNOW WHAT WE DO, CONDITIONS FOR REQUIREMENT AND REQUIREMENTS FOR PARTICIPATION, SO MANY OF THE THINGS ARE YOU TALKING ABOUT TODAY I HAVE BEEN INVOLVED WITH PATIENTS OVER PAPERWORK PRETTY MUCH SINCE ITS INCEPTION IN VARIOUS WAYS I WANT TO THANK YOU FOR CONTINUING TO ENGAGE ME, I HOPE TO CONTINUE TO PARTICIPATE IN THE INITIATIVE BECAUSE IT’S BEEN INVALUABLE FOR ME THERE ARE MANY WAYS THAT’S TRUE I WILL FOCUS QUICKLY ON ONE IN THE SAKE OF TIME AND THAT IS THAT OPPORTUNITY TO GO OUT AND VISIT PROVIDERS AND SPEAK DIRECTLY WITH FRONT LINE HEALTHCARE DELIVERERS I AM A NURSE BY BACKGROUND I HAVE DONE THIS BUT I HAVE ALSO BEEN IN THE BUREAUCRATIC SETTING FOR A LONG

TIME SO IT WAS VERY VALUABLE TO GO TO A CRITICAL ACCESS HOSPITAL AND TALK TO THE NURSE WHO FILLS HALF A DOZEN ROLES TO THE DISCHARGE PLANNER WHO HAS TO FIGURE OUT HOW TO ACCESS ALL THE RIGHT SERVICES IN AN UNDERSERVED AREA TO MAKE SURE HER PATIENTS GO HOME SAFELY TO THE PEOPLE IN THE EMERGENCY ROOM WHO DEAL WITH ALL KINDS OF THINGS I MIGHT NOT NECESSARILY HAVE THOUGHT ABOUT THEM DEALING WITH IN A RURAL SETTING TO GO TO A HOME HEALTH SETTING AND SEE HOW HARD IT IS FOR THE PERSON WHO PUTS ALL THE CLAIM INFORMATION IN THE SYSTEM THAT’S IN A DIFFERENT PLACE THEY ARE PUTTING MEDICAL RECORD INFORMATION AND WHAT THEY GET AND WHAT THEY SEE AND DON’T SEE ALL OF THE COMPLEXITY OF IT AND TO ACTUALLY GO OUT WITH AN OCCUPATIONAL THERAPIST TO SEE PATIENTS AND HEAR THE PATIENTS SAY HOW CAN WE COME INTO THE HOME AND DO THESE THINGS IS MEANINGFUL ALL THESE I DID IN MY NON TYPICAL ROLE OF BEING QUIET AND LISTENING TO WHAT SOMEBODY SAID NOT JUSTIFYING, NOT EXPLAINING OR CORRECTING MY JOB WAS TO LISTEN AND HEAR AND TO BRING IT BACK AND THAT WAS THE MOST VALUABLE THING I THINK I COULD DO IN THAT SETTING BECAUSE IT’S DIFFERENT FROM GOING ON A SURVEY, GOING ON A SITE VISIT, ALL THOSE THINGS I HAVE ENCOURAGED MY STAFF TO PARTICIPATE, THEY ALL FOUND IT SIMILARLY HELPFUL AND BENEFICIAL I HOPE TO CONTINUE TO DO MORE OF IT, BECAUSE IT REALLY BROUGHT HOME TO ME THE PATIENT AT THE CENTER AND PART OF OUR JOB IS JUST TO LISTEN AND HEAR WHAT YOU HAVE TO SAY ABOUT HOW WE GET OUT OF THE WAY TO DELIVER CARE TO THE PATIENT IN A SAFE, EFFECTIVE AND EFFICIENT WAY I WILL END AND TURN IT OVER TO DR. GREEN BECAUSE THE REST OF THE DAY IS ABOUT LISTENING [ APPLAUSE ] >> I MENTIONED IT’S WONDERFUL TO HEAR THE IMPACT THE PATIENTS OVER PAPERWORK IS MAKING TO DATE WE ALL KNOW THERE’S PLENTY MORE WORK TO DO WE NEVER GIVE UP AN OPPORTUNITY TO GET INPUT FROM OUR STAKEHOLDERS WE ARE GOING TO CONDUCT SOME LISTENING SESSIONS OVER THE NEXT 40 MINUTES OR SO AND FOR THOSE PARTICIPATING IN THE LISTENING SESSIONS, IF YOU LOOK AT THE AGENDA AT THE BOTTOM, THE ONES WE WILL HAVE ARE CONDITIONS OF PARTICIPATION, RURAL HEALTH, VALUE BASED ARRANGEMENTS, MEANINGFUL MEASURES PRIOR AUTHORIZATION, INNOVATION AND PROGRAM INTEGRITY THOSE OF YOU WHO HAVE SIGNED UP TO BE IN THE RURAL HEALTH, MEANINGFUL MEASURES AND INNOVATION SESSION, YOU ARE GOING TO HEAD TO THAT BACK CORNER AND FOCUS ON OUR TEAM, WE WILL ESCORT YOU TO WHERE THE SESSIONS WILL TAKE PLACE THE OTHER SESSIONS, THOSE WILL HAPPEN AT THE TABLES HERE WE WILL HAVE FACILITATORS AT EACH OF THE TABLES THEY WILL GIVE YOU AN IDEA OF THE KINDS OF INFORMATION WE ARE LOOKING FOR IN THESE PARTICULAR BURDENED AREAS HOWEVER, IF THERE’S SOMETHING ELSE YOU WANT TO TALK ABOUT, YOU KNOW WE ALWAYS WELCOME THAT YOUR JOB AS A TEAM AT THE TABLE IS TO BRAINSTORM AS MUCH AS YOU CAN ON THE KINDS OF THINGS YOU WISH CMS WOULD WORK ON NEXT BUT WHAT WE WOULD LIKE YOU TO WRITE DOWN SO WE CAN RECAP AT THE END IS 2-3 TOP PRIORITY ISSUES WITHIN CONDITIONS OF PARTICIPATION, OR RURAL HEALTH AND THE OTHERS, THAT YOU REALLY WANT TO MAKE SURE CMS CONSIDERS FOCUSING ON ALL RIGHT? SO AT THIS POINT, LET ME JUST CHECK WITH STEPHANIE AT THIS POINT, WHY DON’T YOU GO AHEAD AND HEAD BACK TO THE TABLES YOU ARE ASSIGNED TO REMEMBER THAT SEVERAL OF THEM ARE OUTSIDE OF THE AUDITORIUM