Drowning in a Sea of Medicare Paperwork.

From the WebMD Archives

May 3, 2001 (Washington) -- In a newly sympathetic Washington, health providers are getting heavy in their calls for lighter Medicare paperwork requirements.

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.

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 Disease program.


According to AHA President Dick Davidson, President Bush's health secretary Tommy Thompson found the inclusion of that question "hysterical."

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 this."

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 Association.

And the industry is poised to gain another likely sympathetic ear in Washington. Tom Scully, whom the White House this week formally nominated to run the Medicare program under Thompson, previously ran a national for-profit hospital association.

Hospital officials said that they didn't precisely know how to strike the right mix involving preventing fraud, documenting important medical information, and keeping health professionals from drowning in a sea of Medicare forms.

"I don't know the answer or how to fix this," Mansfield said.

But for starters, the AHA says it wants greater input from providers on new requirements and for Medicare to reflect the cost of complying with new rules into Medicare reimbursement updates. Bipartisan legislation introduced this Congress would require further testing before new documentation requirements are launched for physicians.

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