Pharmacy-related Administrative Processes Frustrate Physicians

AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, reached out to dozens of health plans recently as part of the Academy's ongoing efforts to ease the daily administrative burdens placed on family physicians, especially as concerns pharmacy benefits.

"Let us find ways for family physicians and health and pharmacy benefits entities to collaborate to diminish the physician practice's time spent meeting your plans' pharmacy benefit requirements," wrote Epperly in letters to such payers as Blue Cross and Blue Shield companies, UnitedHealthcare, CIGNA HealthCare and WellPoint Inc.

In the Dec. 8 letter, Epperly urged the health insurance companies to discuss with the AAFP "ways to recognize and compensate family physicians for their work in performing administrative processes related to pharmacy benefits."

Epperly reminded health plans of the results of a 2004 Medical Group Management Association survey that calculated the costs of pharmacy-related administrative processes. The price tag was about $137,000 a year for an average 10-physician practice.

In addition, Epperly cited a 2009 Health Affairs study in which researchers estimated that the median annual costs for a primary care physician to interact with health plans was more than $47,000.

Third-party payers have long argued that physicians are paid for the time spent on administrative processes through evaluation and management codes. But that's just bad math, said Epperly.

"The payment levels for office visits fail to fully account for the amount of time actually necessary, including the time spent related to prescription drug activities," said Epperly. "For instance, for the most common office visit code, 99213, the post-service work dedicated to the patient's treatment plan is only five minutes."

Epperly said that prior authorization programs should support automation and standardization and be transparent. Such an approach would ensure the provision of appropriate patient care but would not financially strain physician practices.

He said electronic prescribing advances "hold promise" but that additional system improvements were necessary.

Epperly urged the health plans to contact the AAFP to schedule follow-up meetings on the issue.