During a Senate Budget Committee hearing last week, Sen. Chuck Grassley (R-IA) questioned witnesses about administrative burdens.
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NewsTranscript
00:00 I'm going to ask all my questions of Dr. DiGiorgio.
00:04 Your testimony talks about the weight
00:07 of daily administrative burdens put on doctors
00:11 and frontline healthcare workers.
00:12 What's the source of these administrative burdens?
00:16 Can you give an example of a top-down regulation the federal
00:20 government should remove today
00:21 that wouldn't compromise patient safety or quality?
00:24 I think, broadly speaking, what I'd really like to see is a
00:28 shift from CMS being a plan provider
00:32 to being a plan regulator.
00:33 I think CMS is largely focused on the minutiae
00:36 of the fee schedule, and unburdening CMS
00:38 from that would allow it to focus more on things
00:41 like the adequate risk adjustment model
00:43 and population health quality control.
00:46 And then, specifically, I'd love to see CMS go on a quality diet.
00:49 I'd like it to install a living system of quality metrics
00:53 where metrics are retired as they're shown
00:54 to no longer be useful, and new metrics can come into place
00:57 that would, instead of focusing on the frontline clinician
01:00 and how we practice care, focus more on larger hospital systems
01:03 and hospital practices,
01:04 helping to improve the clinician experience.
01:07 I think we need to make sure
01:08 that any new quality metrics are easily collected using existing
01:12 technology, and that we're not adding additional administrative
01:15 burden for data collection for these metrics.
01:17 You described the importance
01:21 of fostering competitive dynamic healthcare marketplace
01:26 that values efficiency and quality.
01:28 Is Medicare Advantage a marketplace
01:31 where we can foster competition
01:33 to address administrative burden problems
01:35 in our healthcare system?
01:37 And if so, what can we do to make it more competitive?
01:41 Yes, I think absolutely Medicare Advantage is a space
01:44 that could foster competition, but there has
01:45 to be a lot more competition.
01:46 If we're talking about inefficient prior authorizations,
01:49 we shouldn't need to regulate efficiency in the health plans
01:52 if there is adequate competition.
01:54 So I think we need to improve competition
01:56 with more plans entering the space.
01:58 And in addition, I'd like to see equalization
02:01 between Medicare fee for service and Medicare Advantage
02:03 with a unified quality reporting system and star rating system
02:06 between the two types of Medicare.
02:08 Your testimony stated employment growth
02:12 of healthcare administrators, outpacing growth in the number
02:18 of new doctors by over 20 to 1 in recent years.
02:22 What are these administrators doing in the healthcare system?
02:25 Who are they and why haven't they returned value
02:30 to our healthcare system and decreased spending?
02:32 Largely what Dr. Cutler mentioned is they are taking all
02:35 of the unstructured data that physicians are putting
02:38 into our clinical documentation and attempting
02:40 to make it structured data to fit
02:42 into certain billing codes and quality metric formula.
02:44 A lot of that could be automated, I believe,
02:46 using again existing technology.
02:49 But really CMS creates sort of a floor
02:51 of the documentation burden.
02:53 So if CMS says that a certain CPT code
02:55 or billing code requires XYZ, then physicians are going
02:58 to be encouraged to put XYZ in every single one of our notes
03:02 to try to get that billing code.
03:03 And then the, again, all these administrators go
03:06 through our notes, try to maximize
03:07 which code can be assigned to each instance
03:09 of clinical documentation and put that in
03:12 and bill it regardless of the payer.
03:13 My last question, your testimony spoke to the lack
03:18 of labor productivity gains in healthcare over recent decades.
03:23 In other words, doctors haven't become more efficient even
03:27 with new technology like electronic medical records.
03:30 How should we approach regulating artificial
03:33 intelligence given the impact
03:35 of top-down regulations on current technology?
03:38 Yes, I think AI has huge potential to do a lot
03:42 of that administrative work.
03:43 Again, taking unstructured data
03:45 and creating structured data out of it.
03:47 I am worried that we would overregulate it.
03:49 If I went back to 1990 and told all physicians that we're going
03:52 to computerize electronic --
03:53 we're going to computerize paper charts
03:55 and have instant access to data and imaging,
03:57 I think everyone would be thrilled with the amount
04:00 of efficiency gains we would have with that technology.
04:02 That never happened because we overregulated EMR
04:05 with things like meaningful use.
04:06 And so I am worried that we would take the same approach
04:09 to AI and take away any potential efficiency gains
04:13 with overregulation.
04:14 Thank you.