The Curbsiders podcast

#120 Health Policy, Patients, Payments, Paperwork

October 19, 2018 | By

Health Policy for Millennials. Join us in this roundtable discussion of patients before paperwork, administrative burden, the new CMS payment model proposal, and a bit on health insurance with cohost, Fatima Syed MD MSc and guest, Deep Shah MD MSc. Doctors Syed and Shah are both early career physicians with masters degrees in comparative social policy from Oxford University and are active members of the American College of Physicians. ACP members can visit to claim free CME-MOC credit for this episode.


Written and produced by: Fatima Syed MD MSc and Matthew Watto MD

CME questions by: Matthew Watto MD

Hosts: Fatima Syed MD MSc, Matthew Watto MD

Guest: Deep Shah MD MSc

Policy Pearls

“We are not on a sustainable course” -Dr Deep Shah

  1. Administrative burden – Dr Shah notes three main sources: 1) clinical documentation 2) the complexities of coding and 3) “Note bloat” aka useless filler without clinical value.
  2. The ACP position statement on reducing administrative burden makes seven recommendations including the need for stakeholders to collaborate with physicians for regular review and revision of administrative tasks with the goal of minimizing burden (Erickson et al Annals Int Med 2017).
  3. A recent study found that physicians spend more than half of their day on documentation (Sinksy et al. Annals Int Med 2016).
  4. Health policies implemented by CMS are often a herald of what will happen throughout the health insurance market. –Dr Shah
  5. In July 2018, Center for Medicare and Medicaid services (CMS) proposed a flat payment rate for patient visits levels 2 through 5. The ACP sent a letter to CMS Administrator Verma cautioning that “the proposal to pay the same for complex cognitive care as more basic care will undermine patients who need our help the most”.
  6. Dr Shah recommends lowering the baseline documentation required for patient visits since much of the documentation is too burdensome and without value for both the sending and receiving clinician.
  7. Dr Shah notes that health innovations and new technologies must be evaluated, and validated before widespread adoption. This might help avoid unintended consequences, as occurred with the rapid adoption of electronic health records and their associated administrative burdens.
  8. Since the passage of the Affordable Care Act, the nonelderly uninsured rate dropped from greater than 16% to 10.3% by 2016 ( Key Facts – Uninsured – November 2017)
  9. Patients can receive health insurance through the government (Medicare, Medicaid, military insurance programs), private insurance (health insurance exchanges, employer-sponsored, out-of-pocket) or go to a federally qualified health center if uninsured. Dr Shah notes that health care is very expensive and few people can afford the out of pocket costs.

Goals and Learning Objectives


Listeners will define administrative burden and its impact on the physician workforce; comprehend the impact of proposed changes to the CMS payment model; and recall the basic ways patients get health insurance.

Learning objectives

After listening to this episode listeners will…

  1. Define administrative burden (tasks)
  2. Identify possible ways to reduce administrative burden
  3. Evaluate proposed changes to physician payments
  4. Explain how these proposed payment changes might affect the care of complex patients
  5. Recall basic sources of health insurance for most patients
  6. Recall the effect of the Affordable Care Act on the uninsured population


Doctors Syed, Shah and Watto report no relevant financial disclosures.

Time Stamps

  • 00:00 Disclaimer, intro, and guest bios
  • 02:18 Guest one liners, book recommendations, picks of the week
  • 11:00 Administrative burden
  • 16:00 Will the documentation problem get better? Suggestions for improvement
  • 25:11 Why do CMS rules spread to the private insurance sector?
  • 29:30 What innovations might reduce administrative burden?
  • 32:40 The Affordable Care Act, health insurance, price transparency
  • 41:20 Take home points
  • 44:20 Outro
  1. Patients before paperwork resources from the ACP
  2. Erickson SM, Rockwern B, Koltov M, McLean RM, for the Medical Practice and Quality Committee of the American College of Physicians. Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians. Ann Intern Med. ;166:659–661. doi: 10.7326/M16-2697 (FREE)

Picks of the Week

  1. When Breath Becomes Air (book) by Paul Kalinithi
  2. Rich Dad, Poor Dad (book) Robert T. Kiyosaki
  3. Dr Shah says “don’t read previous Medscape compensation surveys” – I’ll omit the link : )
  4. for out of pocket drug costs by zip code
  5. On Being a Doctor: A Physician’s Place in the #MeToo Movement. Annals of Internal Medicine. May 2018

CME Partner


The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit and search for this episode to claim credit.

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