Transformations to reduce documentation burden

When it comes to the “3 T’s” of reducing administrative burden—techniques, technologies and transformations—the last one may seem like the biggest hill to climb.

Making structural changes to the way your practice operates, and/or hiring and training new staff, arguably are much more significant steps than incorporating new technologies or methodologies for patient visits. But taking big steps—from expanding nonphysician clinicians’ scope of work to adopting an entirely new practice model—can go a long way toward reducing time spent on electronic health records (EHRs) and other bureaucratic tasks, which are cited as the primary source of physician burnout.

Team documentation can ease burden by having medical assistants (MAs) help the physician with the visit and patient notes. Transforming to a team model requires two main changes to the traditional practice model:

Family physicians who report burnout often describe being on a “hamster wheel”— always running, rushed and never caught up. Time caring for patients and time with their families is compromised, and their professional satisfaction is eroded.

Under the fee-for-service (FFS) reimbursement model, physicians cover large patient panels (1,500–2,500 individuals), conduct severely time-restricted visits (~15 minutes) and spend ~40% of their time documenting their work to get paid. For these and other reasons, FFS-based, insurance-driven primary care has been labeled a primary cause of family physician burnout, in contrast to an innovative, alternative model to FFS: direct primary care (DPC).

Below are quantitative results and interview findings for 10 clinicians before and after adopting DPC and Hint Health’s DPC membership management solution, HintOS. The results present anecdotal evidence of these clinicians’ experiences based on their reported levels of practice satisfaction, burden and burnout.

Clinicians saw a dramatic increase in overall practice satisfaction, with the average score more than doubling from 4.1 to 8.9 on a scale of 1 to 10. When asked what would raise their satisfaction score with their current practice to 10, they often reported they still wanted to grow their patient panels or offer more services. A few reported that feeling outside of the system, although refreshing, was at times frustrating when trying to get information that would assist their patients.

At the heart of clinicians’ responses was their strong dissatisfaction with the practice burdens associated with FFS. They reported low satisfaction under the FFS model—an average of 2.9 on a scale of 1 to 10—with several reporting that they felt they were on a “hamster wheel” and were never able to catch up or get paid adequately. After adopting DPC, they reported a 9.7 satisfaction rating, stating that they no longer worried about or even had to work specifically on getting paid simply for providing care.

Clinicians said that HintOS removed all of the administrative burden that could be associated with the prospective payment membership model because it managed the payments and reminders without clinicians having to insert themselves into the payment process. The only reason they really even needed to go into HintOS, they said, was to see “how well it was going.”

Regarding patient panel size under FFS, our participants had only three definitive data points (1,400, 1,500, and 3,000 patients), with an average just under 2,000 patients. Estimates of typical primary care patient panel size under FFS range from 1,500–2,500 patients. With an n of 10, the participants reported their DPC patient panel sizes ranged from 150–800, with an average of 453. Most reported their ideal patient panel size would be 500–800 patients. Some wanted to keep their panel size on the smaller end to maintain a good work-life balance.

Participants reported a threefold increase in typical visit length, going from an average of just under 15 minutes to an average of about 45 minutes. They reported that they thought an ideal FFS visit length should be 30 minutes. Typically under DPC, they would schedule patients for 30–45 minutes for routine visits and 60-plus minutes for new patients because they considered these the ideal visit lengths to take care of patients. Their schedule often allowed them to extend these visits as needed.

How would you rate your time with your patients?

1. Inadequate
2. Constrained
3. Adequate
4. Ample

In a follow-up to the question about visit length, participants described their time with their patients as moving from between “inadequate” and “constrained” under FFS to unanimously reporting that under DPC, their time with their patients was “ample.”