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Tuesday Feb 27, 2018

Real Action on Administrative Burden Is Long Overdue

On a recent Friday night, I found myself sitting in my office at 7:30 p.m., updating electronic health records (EHRs) 2 1/2 hours after my last patient had left the building. I could have stayed and powered my way through the rest of a long day's charts. Instead, I got mad and went home.

[physician with laptop looking stressed out]

I've been using an EHR for a long time. The one I use now is certified to the latest standards, which means it does everything the government says it should do. Unfortunately, that doesn't mean it does everything I want it to do.

I've been practicing family medicine for more than 35 years in the same small town where I grew up. I spend about seven hours a day seeing patients, and that's something I love. The issue is that seven hours of patient care requires another seven hours -- or more -- of administrative work. Half my workday (or night) is spent sitting in front of a screen. At times, I feel like I've become an expensive data entry clerk.

No thanks, I'd rather be a family physician.

EHRs may be more legible than our old paper charts, but it's even harder to find meaningful information in the morass of extraneous information than it was in an old-style, handwritten note.

Now, no one thinks we're going back to paper charts, but why, after all this time, is using an EHR still this complicated, time-consuming and counterproductive?

The first EHR system was invented in 1972.(1qblb015q58ipcln51ov1m9g-wpengine.netdna-ssl.com) Adoption spread with the proliferation of personal computers in the 1980s and the internet in the 1990s. The potential of the EHR to help us better track disease and outcomes, manage population health, and communicate with other physicians and hospitals has been tantalizing. The reality is that here we still are, cursing our keyboards and hating our EHRs to the point that physicians are experiencing burnout, closing independent practices, retiring early and opting out of traditional practice models.

Reducing administrative burden is one of the Academy's top priorities, so I want to offer an update on the latest developments on that front.

On Jan. 10, AAFP CEO and EVP Douglas Henley, M.D., and Shawn Martin, senior vice president of advocacy, practice advancement and policy, attended a joint meeting of CMS and the Office of the National Coordinator for Health IT (ONC) regarding administrative burden. Steven Waldren, M.D., director of the AAFP's Alliance for eHealth Innovation, attended a Feb. 22 followup meeting in which stakeholders were able to provide input and suggest potential solutions.

Between those two meetings, the AAFP sent a letter to CMS and ONC that recommended

  • eliminating codes 99211-99215 and 99201-99205 for primary care physicians,
  • allowing all members of the care team to enter information related to a patient's visit,
  • having EHR vendors and workflow engineers collaborate with physicians to create better systems, and
  • simplifying quality measures by having all insurers implement those adopted by the Core Quality Measures Collaborative.  

The Academy also made several recommendations related to prior authorizations, including the idea that all insurers should use a standard form and that prior authorization be eliminated for standard, inexpensive drugs. The Academy also recommended that insurers be required to pay physicians for the time we spend on prior authorizations that exceed a certain number or that are not resolved in a timely fashion.

The AAFP also recently provided ONC with feedback on its draft document regarding interoperability.

Our in-person dialogue with ONC and CMS is ongoing. AAFP officers, including me, also have met with representatives from both agencies. And AAFP President Michael Munger, M.D., of Overland Park, Kan., spoke at a CMS roundtable on administrative burden in October.

Our efforts to reduce administrative burden extend beyond the federal agencies. This week, the AAFP Board of Directors will be on Capitol Hill to meet with legislators and congressional staff, and administrative burden will be one of the top items on our agenda. Our message, to both Congress and the federal agencies, is clear: Something must change, and change is long overdue.

We spend a full day taking care of patients. It shouldn't take another seven to eight hours trying to get paid, meet quality measures and justify our decisions. Physicians and our communities would both benefit greatly if payers and policymakers would allow us to focus on our patients.

John Meigs, M.D., is Board chair of the AAFP.

Posted at 03:21PM Feb 27, 2018 by John Meigs, M.D.

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