We Must Reduce Administrative Burdens on Physicians

Thursday, April 20, 2017 | Larry Sobal

 

In my blog last week, I wrote about our recent visit to Washington DC to meet with key legislative influencers of our health care public policy. A top priority was to seek understanding about and relief from the toll of Administrative Burdens on physicians. Based on the number of emails and comments I received to last week’s post, it seems the topic of administrative burdens hit a nerve.

Apparently, there are many others who feel strongly about the need to lessen the administrative burdens on physicians, especially physicians themselves. For example, not long ago the American Medical Association (AMA) and a number of other physician societies wrote to recently appointed Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma, calling for a very broad exception from 2018 Meaningful Use, Physician Quality Reporting System (PQRS), and value-based payment modifier (VBM) penalties due to the administrative burden of reporting under these programs.

The fact is, we are burying our physicians under administrative duties that take them away from patient care.  All of the physicians I’ve ever worked with embarked on a career in medicine to help patients. But today, many are finding their days consumed with the administrative burdens required to comply with the massive changes brought about by health care reform efforts and dysfunctional EHRs. Not surprisingly, physicians have become increasingly vocal about the growing burden of administrative work. Various studies have begun highlighting how much time clinicians devote to administrative tasks. The data may surprise you, and should trigger an alarm in all of us

For example, a 2014 study quantified the time U.S. physicians spent on administrative tasks, and its relationship to their career satisfaction, based on a nationally representative survey of 4,720 U.S. physicians working 20 or more hours per week in direct patient care. The results showed the average doctor spent 8.7 hours per week (16.6% of working hours) on administration.

More recently, researchers from Dartmouth-Hitchcock health system observed 57 U.S. providers who practiced cardiology, family medicine, orthopedics, or internal medicine in four states. The study found that physicians spent 27 percent of their office day on direct clinical face time with patients and spent 49.2 percent of their office day on EHRs and other desk work. When in the examination room with patients, physicians spent 52.9 percent of their time directly talking with patients and 37 percent of their time on EHR and other desk work.

The study found that physicians spent 49.2 percent of their office day on EHRs and other desk work.

 

And just a few weeks ago, a collection of health care CEOs from the AMA, Partners HealthCare, Mayo Clinic, Cleveland Clinic, Atrius Health, and other organizations called the industry’s attention to physician burnout as a public health crisis. “The high level of burnout among physicians should be considered an early warning sign of dysfunction in our health care system,” they wrote. “Professional satisfaction for physicians is primarily driven by the ability to provide high-quality care to patients in an efficient manner. Dissatisfaction is driven by factors that impede this effort, including administrative and regulatory burdens, limitations of current technology, an inefficient practice environment, excessive clerical work, and conflicting payer requirements. High levels of physician burnout can thus be seen as an indicator of poor performance by the underlying system and environment.”

These and other studies are finding that administrative burdens are more likely to impact physicians in large practices, those in practices owned by a hospital, and those with financial incentives to reduce services spent more time on administration. Furthermore, more extensive use of electronic medical records was associated with a greater administrative burden. Doctors spending more time on administration had lower career satisfaction, even after controlling for income and other factors. Current trends in U.S. health policy--a shift to employment in large practices, the implementation of electronic medical records, and the increasing prevalence of financial risk sharing--are likely to increase doctors' paperwork burdens and may decrease their career satisfaction.

What can be done about it?  I think there are a number of solutions including the following.

At a legislative level:

• Eliminate Stage 3 of the Meaningful Use EHR Incentive Program with no new MU requirements or thresholds being implemented beyond those already in place under the Modified Stage 2 rule.
• Any annual data reporting periods for MIPS and other CMS programs should not exceed 90 days within any given year.
• Rules must be simplified – given all the other changes happening concurrently (i.e. Alternative Payment Models, MIPS, AUC, etc.), make sure that there is cross over so that submitting data for one program also meets requirements for others at the same time.
• Develop uniform federal standards for technical EHR certification.
• Penalize vendors to ensure they develop high-quality products that support interoperability across multiple EHR systems with HHS mandating and imposing penalties to decertify systems that take part in actions that hinder true interoperability.
• End information blocking (i.e., vendors putting obstacles in the way of sharing data among various systems) and give the OIG (and/or other relevant federal agency) the authority to investigate and establish deterrents to information blocking practices.

At an organizational level:

• Minimize the role that physicians play in attaining prior-authorization.
• Optimize protocols and standing orders so that non-physician staff appropriately take on tasks and processes that divert administrative work from physicians. An example is having a Medical Assistant (MA) assume responsibility for many of the forms (durable medical equipment, work, college, prior authorization of medications or imaging procedures, and disability) that clog a physician’s desk.
• Greater use of scribes to reduce WAC (i.e. work after clinic – usually EHR related) that has become so prevalent due to the inefficiency of EHRs.
• Adoption of team-based care where Advanced Practice Providers, RNs and MAs all collaborate to work at the top of their licenses.

To its credit, CMS announced last fall a new initiative designed to improve the clinician experience, but I have not been able to find any current data on its activity. Let’s hope it doesn’t get lost in the priorities of the new administration.

Forgive me if I make one last plea from my cyberspace soapbox, but one of the contributors to administrative burden is the need to rethink the health industry’s obsession with collecting quality metrics, many of which can arguably be considered of little or no correlation to quality. The CMS measure inventory catalogs nearly 1,700 measures being submitted, and the National Quality Forum’s measure database includes 630 measures, not to mention all the other ACO and health plan measures. Does this contribute to the administrative burden of physicians? You bet, to the tune of more than $15.4 billion annually in lost physician time.

The US health industry can no longer afford to ignore the problem of administrative burdens on physicians. What are your solutions?

 

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at www.medaxiom.com.

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