May 3, 2001 (Washington) -- In a newly sympathetic Washington,
health providers are getting heavy in their calls for lighter Medicare
According to a new survey paid for by the American Hospital
Association, every hour of patient care in the emergency department requires
one hour of Medicare paperwork, with every hour of home health services
requiring 48 minutes of paperwork.
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Scores of new Medicare rules have hit the books since 1997,
when a reform bill was enacted. The hospital group claimed that there are
layers and layers of unnecessary and confusing bureaucratic requirements that
are frustrating both caregivers and patients.
At the same time, the Bush administration has signaled that it
views Medicare's paperwork rules as needing major streamlining, as lawmakers of
both parties introduce legislation to similar ends.
Uwe Reinhardt, PhD, a Princeton University health economist,
tells WebMD that hospitals and health professionals bring "a very
legitimate claim." At the same time, he acknowledges, some paperwork is
essential to medically document services and help prevent fraud.
At a "regulatory relief" press conference this week,
officials with the hospital association dramatically unfurled a
100-question-plus form that patients must complete before they start receiving
services from a home health agency.
The form can take a frail patient 90 minutes to complete, said
Bruce Cummings, chief executive of Blue Hill Memorial Hospital, a small
hospital in rural Maine.
Medicare patients must complete eight different Medicare forms
upon arrival at the ER.
Additional documentation requirements placed on ER doctors can
increase the length of stay and waiting time for elderly emergency room
patients, Philip Strauss, MD, tells WebMD. "It certainly impacts patient
satisfaction," he adds. Straus is an emergency physician at Suburban
Hospital in Bethesda, Md.
Debbie Mansfield, RN, said that patients sometimes
"cry" over the duplicative forms that they must complete and blame the
paperwork on nurses or doctors. Moreover, she tells WebMD, all the forms that
nurses must fill out leave them less time for compassion toward patients.
Mansfield is a nurse manager at Methodist Hospital in Gary, Ind.
Industry officials also complained that patients are also
required to fill out a 30-item Medicare form at every hospital visit. The form,
which confirms that Medicare is the primary insurer, includes such detailed
queries as whether patients are beneficiaries of a special federal Black Lung
According to AHA President Dick Davidson, President Bush's
health secretary Tommy Thompson found the inclusion of that question
Davidson said that Thompson has similar views on the paperwork
burden. He "made it clear that he think it's as dumb as we do,"
Davidson said. "There's a readiness to finally want to deal with
Thompson has already announced a "comprehensive management
review" to "modernize and reform" the Medicare agency. As part of
this effort, for this week, he has moved his offices to the agency's
headquarters in Baltimore. Thompson has even mentioned renaming this dreaded
administration, known as HCFA, as "MAMA" -- the Medicare and Medicaid