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Tuesday Oct 24, 2017

If Payers Could Reduce Administrative Burden, 'That'd Be Great'

"You see, we are putting the cover sheets on all TPS reports before they go out. Did you see the memo about this?"
-- Bill Lumbergh to Peter Gibbons in "Office Space"

The quote above is from a scene in the classic movie Office Space, where the main character (Peter Gibbons) has a conversation with his boss (Bill Lumbergh) about his continued failure to comply with the company's new policy regarding "TPS reports." The comedy follows the day-to-day interactions of Peter and his co-workers and their growing frustration with the administrative burdens of their jobs. It is that mundane administrative complexity that drives Peter and his co-workers to a breaking point. If you have seen the movie, you know that they retaliate in the end.

[red stapler]

If you exchanged the words "TPS reports" with "prior authorization form," "documentation guidelines" or "quality measures," you could easily have made this movie about modern-day family medicine practice. Like the characters in the movie, family physicians are feeling the strain of a complex regulatory system and work environment. During the past decade, the amount of administrative work associated with a medical practice has increased dramatically. Although much of the increased burden stems from electronic health records, there are other drivers of administrative burden -- most notably the mind-numbing and time-evaporating prior authorization process used by every health insurer.

I have written on the issue of administrative and regulatory burden and the AAFP's advocacy efforts related to the issue a couple of times in the past year. You can read those posts here.
and here. Each time I broach this subject, the statistic that always drives my thinking is from a 2016 study in the Annals of Internal Medicine(annals.org) that found that during a typical day, primary care physicians spend 27 percent of their time on clinical activities and 49 percent on administrative activities. The authors concluded that for every hour primary care physicians spend in direct patient care, they spend two hours engaged in administrative functions.

To put this a different way, you spend twice as much time doing things for third parties as you do providing care to patients.

Although these statistics are not surprising, they are nonetheless maddening. There is little doubt that administrative and regulatory burden are hindering quality patient care and are the primary drivers of physician burnout. Earlier this year, the AAFP surveyed members about physician burnout, and the feedback was compelling. The issue is real, but the desire was to address the causes not the symptoms. You told us in no uncertain terms, "Don't focus on fixing me, focus on fixing the system." As I stated in my speech at AAFP FMX in September, "That message has been received, and that challenge has been accepted. The most important thing you do every day should not be your EHR, it should not be maintenance of certification, and it shouldn't be prior authorization. The most important thing you do every day should be being a compassionate listener and provider of care to the person sitting in the room with you."

Recognizing the importance of our work on this issue, the AAFP is devoting substantial resources to this effort. Our investment includes advocacy at the highest levels of government and with insurance companies. On Oct. 26, AAFP President Michael Munger, M.D., will be meeting with CMS Administrator Seema Verma to continue our work on identifying and implementing policies aimed at reducing the administrative burden on family physicians. This is our third meeting regarding this topic with CMS leadership this year.

We are strongly supportive of the administration's commitment to reducing the volume of complex regulations that contribute to the 2:1 time deficit I mentioned above. Throughout this process, the administration has been a focused and action-oriented partner and we look forward to continuing our efforts to engage with them on achieving meaningful administrative relief for family physicians.

Administrative burden is not solely a Medicare or Medicaid issue, so we also are pressing insurance companies to engage with us on identifying ways to reduce burden and improve efficiencies in the interactions between family physicians and insurers. On Oct. 4, the AAFP met with the CEO and senior staff of America's Health Insurance Plans (AHIP) to discuss how we can accomplish this goal.

The issue of physician well-being and burnout has garnered national attention during the past few years. In addition to our advocacy work to address the underlying drivers of physician burnout, the AAFP is focusing on assisting our members who are experiencing burnout. My colleague Clif Knight, M.D., AAFP Senior Vice President of Education, is widely recognized as a national expert on the issue and is leading the Academy's work in this area.

The AAFP has made physician well-being and wellness a priority. Last month, we launched the Physician Health First Initiative, which features extensive resources aimed at providing information and tools to assist you in caring for yourself and achieving personal and professional satisfaction. The "My Well-Being Resource" section features an exhaustive list of easily navigated, highly impactful resources, including access to the Maslach Burnout Inventory. If you have 10 minutes, take the inventory and evaluate where you are on the well-being continuum.

In addition, the AAFP will host its inaugural Family Physician Health and Well-Being Conference April 18-21, 2018, in Naples, Fla. This conference will allow you to learn from national experts on physician well-being. This is an excellent opportunity to join other family physicians and spend a few days focusing on individual wellness, while discovering solutions for improved professional satisfaction and better patient care within a broken system. Registration is open.

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Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.