A New Use for Onerous Requirements
It is well recognized by users of EHRs that CMS/ONC reporting and use requirements are burdensome and often not connected with desirable patient outcomes, and certainly not connected with efficient operations. This ongoing burdensomeness is illustrated by the recent 1473-page proposed rule for “Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program”.
Of course, reviewing 1473 pages, and commenting on them if so inclined, is itself burdensome. But if you did review them you might notice that the word burdensome occurs 32 times and burden 570 times, although some of the latter are not about administrative burdens. Most of the time the terms appear when admitting to there being a burden, and promising to be less burdensome, or perhaps the least burdensome. “Least” one might note is itself an admission of burdensomeness. One fine sentence in this regard begins “We are not categorically opposed to changes in process or methodology that might reduce the burden of conducting surveys…” The alternative of being categorically opposed to reducing burden would be quite something. Dr Rucker of ONC noted that “This proposal would help to significantly reduce administrative burdens imposed on the nation’s clinicians, allowing them to spend more time with their patients.” One wonders where that sentiment was when the burdens were imposed in the first place. One also wonders if any agency ever declared a regulation to be, say, the third least burdensome.
The creation of burdens, asserting that they are the “least”, and/or promising to reduce the burdens already created is routine business in regulation land. But recently there was a new approach to the creation and use of burdensomeness. CMS announced that they are advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration which would waive MIPS requirements for clinicians who participate sufficiently in certain Medicare Advantage plans. In other words, MIPS is so burdensome that we can get you to do something else we want you to do by letting you off the MIPS hook. This strategy might have widespread utility. First you demand that someone must do something that is clearly oppressive, and then you waive that demand if they agree to do something else that you want done.