AAFP Adopts Principles for Administrative Simplification

Academy Takes Action on FPs' Most Pressing Priority

January 16, 2018 04:05 pm News Staff

The AAFP Board of Directors has adopted the Academy's own "Principles for Administrative Simplification" to address issues of critical importance to family physicians in clinical practice.

[person drawing administrative buden in red ink on graph]

The principles were crafted by the AAFP's Commission on Quality and Practice, which noted that administrative simplification is a strategic priority for the AAFP.

In fact, 60 percent of members who responded to the Academy's 2017 member satisfaction survey asked that administrative simplification be elevated to AAFP's top priority.

The principles address what family physicians know has become an "untenable level" of administrative burden that

  • drives up practice operating costs,
  • reduces face time with patients,
  • causes physician burnout, and
  • thwarts attainability of the quadruple aim of better patient health, better health care delivery, lower costs and higher physician job satisfaction.

"The regulatory framework with which primary care physicians must comply is daunting and often demoralizing," says the principles document. Physicians may deal with 10 different payers, each with its own rules and forms, meaning physicians "spend countless hours reviewing documents and checking boxes to meet the requirements of health insurance plans."

Story Highlights
  • The AAFP Board of Directors has adopted a set of principles that seeks to lessen the administrative burden on family physicians.
  • The four-part "Principles for Administrative Simplification" covers prior authorization, quality measure harmonization, certification and documentation of medical services and supplies, and medical record documentation.
  • The AAFP's Commission on Quality and Practice crafted the principles and noted that administrative simplification is a priority for members.  

The administrative simplification principles are divided into four sections that represent the areas that need immediate attention to ensure that patients have timely access to treatment and that physicians get relief from crushing administrative burden.

Prior Authorization

Family physicians consistently point to prior authorizations as a major source of frustration -- so much so that in May 2017, the AAFP adopted an official policy on prior authorizations. The new principles mirror some of that language.

For instance, the principles state that prior authorization activities must be justified "in terms of financial recovery, cost of administration, workflow burden and lack of another feasible method of utilization control."

Rules and criteria must be transparent and available to the prescribing physician at the point of care, and criteria for denials should be provided along with alternative choices for medications.

Prior authorizations should be waived for physicians who have "proven successful stewardship" and for those participating in financial incentives programs such as shared savings. And the AAFP wants prior authorizations to be eliminated altogether for durable medical equipment (DME), supplies and generic drugs.

This section also suggests some transitional steps that include limiting the number of products and services requiring prior authorization, adopting a standardized form and process to be used by all payers, and prohibiting repeated prior authorizations for patients with chronic diseases, as well as for standard and inexpensive drugs.

Quality Measure Harmonization

The AAFP notes that the proliferation of quality measures in the past 15 years has led to "significant compliance burden" and calls for the adoption of a single set of quality measures based on evidence-based outcomes.

The Academy urges universal implementation of the core measure sets developed by the Core Quality Measures Collaborative -- a multi-stakeholder group in which the AAFP plays a leading role.

Other principles related to quality measures address AAFP's concerns that measures should

  • be practical across a variety of practice settings,
  • include cost of care along with quality and appropriateness,
  • be updated regularly in light of new evidence, and
  • sunset as new quality measures are adopted.

The AAFP also advocates for simplified feedback reports that are standardized across payers, calls for payer transparency regarding rating and ranking methodologies, and asks payers to consider the burden of data collection.

Certification and Documentation

The principles state that family physicians' first priority is providing patients with the medical services and supplies they need to manage their health conditions.

The AAFP wants physicians' orders to be sufficient for patients to receive physical therapy, home health care, hospice care and DME, including diabetic supplies.

The principles also call for

  • rescinding requirements that physicians annually recertify DME supplies for patients with chronic conditions,
  • generic authorization of supplies that allows patients to switch brands without further action from the prescribing physician, and
  • standardized authorization forms that work for all payers.

Additionally, the principles say physicians should not have to attest to a patient's status when a service is provided by another licensed health care professional.

Medical Record Documentation

The AAFP points out that documentation burdens have increased dramatically for physicians despite the proliferation of electronic health records (EHRs), particularly in the area of evaluation and management (E/M) services.

Therefore, the principles call for eliminating documentation for E/M codes 99211-99215 and 99201-99205 for primary care physicians participating in the Quality Payment Program.

In addition, the AAFP wants changes made to the E/M documentation guidelines, along with Medicare's Program Integrity Manuel, that include "the acceptability of medical information entered by any care team member related to a patient's visit."

A third principle states that medical record documentation exists to "record essential elements of the patient encounter and communicate that information to other providers," rendering the use of templates and checked boxes as just administrative work.

The final principle in this group calls on EHR vendors, workflow engineers and physicians to work together to "redesign and optimize EHR systems."

The AAFP's next step in lessening physicians' administrative burden is communicating the new principles to public and private payers in upcoming meetings and letters.

Related AAFP News Coverage
New AAFP Policy Takes Aim at Prior Authorizations
(5/26/2017)

Fresh Perspectives Blog: Prior Authorization Call Shows Inefficiency, Absurdity of Process
(7/18/2016)

More From AAFP
Quality Measures: The Core Quality Measures Collaborative