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Tuesday Oct 31, 2017

Let Us Focus on Patients, Not Paperwork

Family physicians are drowning in administrative burden, routinely wasting our valuable time on required tasks that add little or nothing to patient care. In the AAFP's most recent Member Satisfaction Survey, administrative burden was the No. 1 item that members asked the Academy to help them with.  

[Man slogging through tunnel of paperwork]

We all feel the pain of the ever-growing layers of bureaucracy being piled upon us. As each year passes, more forms are demanded for the authorization of durable medical equipment, radiologic procedures and medications. Many times, prior authorizations are required even for generic medications, or worse yet, for an ongoing medication that already has proven beneficial in the long-term management of a chronic disease. Mandating that physicians jump through the hoops of filling out forms or requiring patients to repeat a step-therapy approach that has already failed disrupts patient care, is unsafe and flies in the face of common sense.

However, all that is just the tip of the proverbial iceberg. Decades-old documentation guidelines for evaluation and management codes, which reflect the majority of our day in family medicine, do not translate to current practice. When combined with death-by-a-thousand-clicks electronic health records technology, what is created represents not just"note bloat" but a needlessly complicated document that hinders meaningful patient care and overall comprehensive coordination. It is painful to try to read through a five-page tome to find exactly what condition or issue the patient presented with, and the resultant key findings and care plan. Just when I think there is nothing else I can see or experience after 31 years of practice that would make me shake my head with incredulity, I start another day of patient care, complete with yet more meaningless administrative tasks.

These impediments to patient care are not just frustrating, they are increasing our costs of doing business -- in both the physician time and the actual money required to complete these pointless tasks. A 2016 study published in Health Affairs(www.physiciansfoundation.org) found that primary care physicians were spending 3.9 hours every week reporting on quality measures for performance programs. The study further estimated that the average annual cost of compliance for these quality programs alone was $40,069 per physician. This is devastating for practices that already operate on the thinnest of margins.

A 2016 study published in Annals of Internal Medicine(annals.org) reported that during a typical day, primary care physicians spend 27 percent of their time on direct patient care but an amazing 49 percent on administrative activities. This discrepancy further serves only to cripple those in independent practice and is a leading reason physicians leave such settings to become employed. It is also a major driver of physician burnout.

On Oct. 26, I had the privilege of presenting comments at a CMS roundtable(280 KB PDF) on administrative burden chaired by CMS Administrator Seema Verma, M.P.H. The AAFP was one of only three organizations -- and the only physician organization -- invited to provide a presentation. I emphasized our pain and the true crisis that this represents to providing comprehensive, coordinated care to our patients. I offered three concrete steps to decrease the administrivia:

  • Eliminate or significantly reduce the use of prior authorizations for durable medical equipment, diabetic supplies and generic medications.
  • Eliminate the documentation guidelines for evaluation and management codes 99211-99215 and 99201-99205 for all primary care physicians.
  • And finally, repeal the regulatory framework of the advancing care information component of the Quality Payment Program and simply require physicians to use a certified electronic health record.

I walked away from the meeting with hope. Verma announced a new CMS initiative, Patients Over Paperwork,(www.modernhealthcare.com) that the agency is beginning using a three-pronged approach. The plan is to increase outreach to physicians, other medical professionals and hospitals to better understand the scope of the administrative burden problem and obtain examples of how this needless complexity is affecting patient care. A goal has been set to decrease the time we spend doing administrative tasks. CMS also aims to harmonize and streamline the forms needed for processes such as prior authorizations.

We have a long road to travel before we can turn our full attention away from the unnecessary hassles that burden our practices and back to our patients. However, CMS has made a commitment to listen and attempt to decrease this burden. This appears to be an opportunity to continue our ongoing advocacy efforts and work with the agency to begin a process that could make a meaningful change for all of us.

Your AAFP has heard you, and I will continue to carry our voice forward at every opportunity.

Michael Munger, M.D., is president of the AAFP.  

Posted at 01:00PM Oct 31, 2017 by Michael Munger, M.D.

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