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Tuesday Oct 27, 2015

Whack the 'WAC'

How many of you can relate to this statement? "I am self-employed, but I work for the government and insurance companies."

This is a common refrain from physicians in all specialties, but it is an especially frequent complaint among family physicians. The administrative burden on family physicians is mind boggling. A majority of family physicians have contractual relationships with seven or more payers. That means there are seven different prior authorization forms, seven different quality reporting systems, seven different prescribing formularies, seven different appropriate use programs, seven different … Well, you get the idea.  

Family physicians not only hate red tape, but there is growing evidence that it contributes to lower quality of care and is a major driver of physician burnout.

Have you ever experienced a sequence of events that crystalizes an issue for you? This happened to me earlier this month through a conversation with a family physician from rural North Carolina, a comment by an AAFP member from California, and a statement by a prominent author -- all driving home the same point -- the administrative burden on physicians is a HUGE problem.

This sequence of events started with a phone conversation I had with a family physician in North Carolina who is in a solo practice in a rural community. "You just have no idea how hard it is to take care of my patients," he told me. The thing that caught my attention was the fact that he wasn't complaining about the time, money, or the hassle on him or his staff; his concern was the red tape preventing him from taking care of his patients.  

That conversation was followed by a conversation with a member from California who, during a large meeting, stated that physicians are tired of the "WAC." I was not familiar with that term, so I did what any inquisitive person would do. I shouted out, "What is the WAC?"  He responded, "Work after clinic." This physician said that the volumes of administrative activity that require physicians to spend hours working after seeing patients was hurting patient care and destroying the love of practice among family physicians. He said that the AAFP needed to help physicians "whack the WAC."

The third and final event in this sequence was a paragraph in the closing chapter of Steven Brill's latest book, "America's Bitter Pill," which reads as follows:

"We should recognize that the quality of medical care is going to continue to be jeopardized by the broken economics of the marketplace, which provides rich incentives to everyone except those actually treating all of these newly covered patients. As doctors remain bogged down in paperwork and face mounting business pressures, the portion of our best and brightest who want to care for the sick instead of cashing in on the business of healthcare is likely to drop.”

Administrative simplification is something that has been a priority for the AAFP for many years. AAFP resources on administrative simplification say, in part, "The AAFP is determined to help family physicians reduce these roadblocks by identifying and eliminating regulations and processes that add cost while undermining the efficient and effective delivery of quality care."  

In addition, we have pursued extensive advocacy initiatives aimed at reducing the administrative burden associated with Medicare and Medicaid. These efforts include establishing a core set of primary care quality measures that would be used by all payers, including Medicare. We also continue to press CMS and commercial insurers to forgo the implementation of complex prior authorization and appropriate use programs that delay access to care for patients and add to the “WAC.”

The most meaningful and important work we are doing to "whack the WAC" is our aggressive efforts to delay and reform the flawed meaningful use program. Last week, CMS and the Office of the National Coordinator for Health Information Technology (ONC) advanced meaningful use (MU) stage three regulations despite widespread criticism from the AAFP and other physician organizations.  

In 2009, Congress passed the HITECH Act. This law instructed CMS and ONC to establish a program that would result in the adoption and implementation of electronic health records among physicians, hospitals, and other health care providers. It also instructed ONC to establish a standard for the interoperability of those EHR products. The legislation did not instruct CMS and ONC to create a complex, three-phase regulatory framework that would add layers of administrative complexity on physicians and throw cold water on any enthusiasm that existed among physicians to implement EHRs in their practices, yet this is exactly what has happened.

Only 10 percent of physicians have attested to MU stage two, and 43 percent of physicians face penalties in 2015. It is unacceptable and unreasonable to impose further punishments on physicians when more time and evaluation of the MU program is clearly needed. The AAFP strongly supports Congress' efforts to transition our health care system from paper-based to electronic health records, however, current MU regulations place unnecessary administrative and financial burdens on family physicians, favor software vendors over physicians and patients, and do little to improve the quality of care we provide.

Are you tired of inputting meaningless data into your patient records simply to comply with a regulation and avoid a financial penalty on your practice? Are you tired of your EHR working for vendors and failing to work for you and your patients? It is time to "whack the WAC," and let's start with the meaningful use stage 3 regulations. Use the AAFP's Speak Out resources and tell your representative and senators to pause the implementation of the stage 3 MU regulation. 

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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.