Family physicians spend an inordinate amount of time collecting data, an administrative burden that the AAFP recently told federal agencies they must help reduce to create more time for patient care.
The AAFP recommended several steps toward a solution in a Feb. 7 letter(6 page PDF) to CMS Administrator Seema Verma, M.P.H., and Don Rucker, M.D., the national coordinator for health IT at HHS' Office of the National Coordinator for Health IT (ONC). The letter, signed by AAFP Board Chair John Miegs, M.D., of Centreville, Ala., covered topics from prior authorization to performance measurements.
The AAFP will reiterate its recommendations in a Feb. 22 meeting with CMS and ONC as part of CMS' Patients over Paperwork initiative.(www.cms.gov)
"The AAFP maintains that the current regulatory framework with which primary care physicians must comply is daunting and often demoralizing," the letter stated. "Standardization is not required among public or private payers, and many family physicians participate with 10 or more payers. Physicians spend needless hours reviewing documents and literally checking boxes to meet the requirements of each health insurance plan."
The letter cited multiple studies by the AAFP and others that measured the amount of time physicians devote to administrative tasks. One of these(www.annfammed.org) revealed that family physicians spend nearly six hours each day interacting with electronic health records (EHRs) during and after clinic hours.
- Covering a range of topics from prior authorization to performance measurements, an AAFP letter identified major policy changes that should be made to reduce the administrative burden on physicians.
- The letter spelled out specific areas where the demands of electronic health records and billing requirements are drawing physicians aware from patient care.
- The AAFP will reiterate its points Feb. 22 in a meeting as part of CMS' Patients Over Paperwork initiative.
"It is unfortunate and avoidable that the regulatory framework for physician practices has reduced face-to-face time with patients and increased operating costs at a time when physician payment is stagnant," the AAFP wrote.
The letter spelled out specific administrative burdens that draw physicians away from patient care, including EHR documentation, prior authorization and the proliferation of quality measures.
Documentation requirements for evaluation and management coding continue to increase in the digital age even though the guidelines originated 20 years ago, when paper records were standard. The current guidelines have little to do with patient care and are a "crutch to justify billing levels," the letter noted.
The AAFP called for eliminating codes 99211-99215 and 99201-99205 for primary care physicians, and allowing all members of the care team to enter information related to a patient's visit.
Looking to the near future, EHR vendors and workflow engineers must collaborate with physicians to create new systems that help primary care physicians focus on what matters.
"The primary purpose of medical record documentation should be to record essential elements of the patient encounter and communicate that information to other providers," the letter stated. "The use of templated data and box-checking should be viewed as administrative work that does not contribute to the care and well-being of the patient."
The AAFP called Verma's and Rucker's attention to how prior authorization stands in the way of efficient, high-quality health care. The letter said any demands for prior authorization must be justified in terms of cost and burden, and then laid out several other steps toward a solution.
"Rules and criteria for prior authorization determination must be transparent and available to the prescribing physician at the point of care," the letter stated. "If a service or medication is denied, the reviewing entity should provide the physician with the reasons for denial."
Further, all insurers should use a standard prior authorization form and should eliminate prior authorization for standard, inexpensive drugs.
Prior authorization also should be eliminated for physicians who participate in shared savings programs and those who demonstrate proven ability to provide low-cost, effective care.
Importantly, insurers should be required to pay physicians for the time they spend with prior authorizations that exceed a specified number or that are not resolved within a designated time period.
Another issue that CMS and ONC must address is the proliferation of quality measures meant to analyze physician performance. The AAFP said all insurers should implement the measures adopted by the Core Quality Measures Collaborative, in which the Academy has taken a leading role.
"With many family physicians submitting claims to more than 10 payers, the adoption of a single set of quality measures across all public and private payers is critical," the letter stated.
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