The Quest for Administrative Simplification: What's Being Done
Progress has been made on several fronts, including prior authorization reform and reducing documentation burdens. But there's more work to do.
Fam Pract Manag. 2021 Jul-Aug;28(4):8-11.
Author disclosures: no relevant financial affiliations.
Administrative burdens have long been one of the most frustrating aspects of practicing medicine in the U.S. Physicians report spending an inordinate amount of time doing paperwork for things like prior authorizations, medical record documentation, and, especially lately, data reporting for a variety of quality measurement programs.
A 2019 survey by CompHealth and the American Academy of Family Physicians (AAFP) found that 71% of physicians cited clerical burdens as one of the top causes of unhappiness on the job.1 The AAFP and other groups have heard the calls for administrative simplification and are working toward it on several fronts. The quest can be summarized in this statement from Leo Babauta's book The Power of Less: “Simplicity boils down to two steps: 1. Identify the essential. 2. Eliminate the rest.”
Here's a brief summary of the principles that are guiding the AAFP and a rundown of what's being done to tame the beast of administrative burden.
Administrative burdens are one of the top reasons that independent physician practices close and physicians burn out.
The American Academy of Family Physicians' “Principles for Administrative Simplification” focus on four areas: prior authorizations, certifications, quality measures, and documentation.
Advocacy efforts have led to rule changes and legislative proposals that provide some relief from administrative burdens. But more needs to be done.
PRINCIPLES FOR ADMINISTRATIVE SIMPLIFICATION
The quest for administrative simplicity is inspired by primary care's daunting and often demoralizing regulatory framework. Every payer seems to have its own rules and ways of doing things — a major problem given that many physicians have 10 or more payers. Physicians and their practice teams must learn and navigate the rules and forms of each payer, spending countless hours reviewing documents and checking boxes to meet the plans' requirements.
This reduces time with patients and drives up operating costs for practices. It is one of the reasons independent practices close and a leading cause of physician burnout.2,3 Like the road to hell, the administrative framework in which primary care practices operate is paved with good intentions, but it has expanded to an untenable level and become a significant barrier to achieving the Quadruple Aim.
Spurred by this problem, the AAFP adopted a set of “Principles for Administrative Simplification” in 2018 to focus the organization's advocacy. The principles are meant to ensure patients have timely access to treatment while reducing administrative burdens for physicians. They cover four key areas: prior authorizations, certification and documentation
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1. Saley C. 2019 AAFP/CompHealth physician happiness survey. CompHealth Blog. March 19, 2019. Accessed June 10, 2021. https://comphealth.com/resources/physician-happiness-survey/...
2. Li D, Tutty M. How to sustain independent physician practices. MedCity News. Nov. 12, 2020. Accessed June 10, 2021. https://medcitynews.com/2020/11/how-to-sustain-independent-physician-practices/
3. Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors related to physician burnout and its consequences: a review. Behav Sci (Basel). 2018;8(11):98.
4. Centers for Medicare & Medicaid Services. Reducing provider and patient burden by improving prior authorization processes, and promoting patients' electronic access to health information for Medicaid managed care plans, state Medicaid agencies, CHIP agencies and CHIP managed care entities, and issuers of qualified health plans on the federally-facilitated exchanges. Federal Register. Dec. 18, 2020. Accessed June 10, 2021. https://www.federalregister.gov/documents/2020/12/18/2020-27593/medicaid-program-patient-protection-and-affordable-care-act-reducing-provider-and-patientfpm20210700p8-burdenfpm20210700p8-by
5. Etz RS, Zyzanski SJ, Gonzalez MM, Reves SR, O'Neal JP, Stange KC. A new comprehensive measure of high-value aspects of primary care. Ann Fam Med. 2019;17(3):221–230.
6. Hubbard E. Selected Writings of Elbert Hubbard: His Mintage of Wisdom, Coined from a Life of Love, Laughter and Work, Volume 10. W.H. Wise & Company. 1922.
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