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Reducing Administrative Burdens

Summary

The growing number of administrative tasks imposed on physicians and patients adds unnecessary costs to the U.S. health care system. Excessive administrative tasks divert time and focus from more clinically important activities of physicians and their staffs, such as providing actual care to patients and improving quality, and may prevent patients from receiving timely and appropriate care or treatment.  In addition, administrative tasks are keeping physicians from entering or remaining in primary care and may cause them to decline participation in certain insurance plans. They’re also a major contributor to the “physician burn-out” epidemic.

These tasks can stem from federal health care requirements, as well as from private payers, vendors, and suppliers.  Often administrative tasks are added without any formal assessment of why the task is being proposed, what is intended by the task and its actual impact on physicians and patients (such as diverting physicians from spending time with patients to complying with unnecessary administrative tasks), and whether the tasks could be eliminated, streamlined, or modified to reduce the burden on physicians without harming quality, safety, or program integrity.

In 2015, ACP started the Patients Before Paperwork initiative focused on identifying and prioritizing the top concerns from ACP members related to administrative tasks; educating ACP members about administrative burden issues; advocating to improve the practice environment; and implementing tactics to address major concerns. As part of this ongoing initiative, ACP developed significant policy recommendations to reduce administrative burden. In Spring of 2017, ACP published a position paper titled, “Putting Patients First by Reducing Administrative Tasks in Health Care,” outlining a cohesive framework for identifying and evaluating administrative tasks as well as detailed policy recommendations to reduce excessive administrative tasks across the health care system. Further policy development includes a position paper published in the Fall of 2017 titled, “Promoting Transparency and Alignment in Medicare Advantage,” which calls for transparency within the MA program and alignment of the various Medicare programs to ultimately reduce administrative burden and put high-quality patient care first.

ACP has also urged Congress, in conjunction with federal agencies and other stakeholders, to work together to reduce excessive administrative tasks that negatively impact physicians and their patients.  ACP’s recommendations include:

  • Calling on federal agencies, advisory bodies, and others, to research the effect of administrative tasks on patient and family care experience and outcomes.  Along these lines, and as part of an ACP action plan to operationalize the recommendations in its above-named paper, the College reached out to various sources of administrative tasks (e.g., regulators, EHR vendors, medical device manufacturers, etc), and meetings were held with these stakeholders to discuss policy and establish next steps for future collaboration.  After ACP’s outreach, CMS began two new initiatives in 2017—Patients Over Paperwork and Meaningful Measures—both focused on reducing unnecessary administrative tasks and significantly reflective of ACP’s own policy in this area.
  • Facilitating congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties requiring everyone to recognize their role and responsibility in reducing administrative burdens associated with health IT.  The College has engaged consistently with key health care committees in Congress providing extensive feedback to how Medicare could decrease administrative burden through a new Medicare Red Tape Relief project, as proposed by the House Ways and Means Committee.  ACP intends to continue to participate in the project moving forward. In addition, the recently-enacted Bipartisan Budget Act of 2018 included a provision removing the mandate that electronic health records Meaningful Use/Advancing Care Information standards become more stringent over time, a key priority for ACP.
  • Establishing a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and in collaboration with their professional organizations.  CMS recently announced a change allowing teaching physicians to verify student documentation in a patient’s medical record related to Evaluation and Management Code services. Prior to the change, physicians were required to re-document most work performed by medical students—which is often very thorough and based on careful and supervised evaluation—rather than review, refer to, amend, and/or correct the student note. This change allows teaching physicians to provide a meaningful educational experience for the student within a much more streamlined workflow; thus eliminating an unnecessary administrative burden for teaching physicians and improving the ability for students to feel valued and to learn.

ACTION

Please provide ACP with information regarding the administrative burdens you face on a regular basis via a new online data collection tool. This tool allows you to enter either an administrative task or a best practice (i.e., approach to dealing with an administrative task—this could be one you are using already or a new idea). Eventually, these entries will be added to the Administrative Tasks and Best Practices Library, which will be available online as soon as we have a robust dataset.

Online Data Collection Tool

Resources

For more information and resources for reducing administrative burden please visit our Patients Before Paperwork page.

Any questions, please contact Brooke Rockwern at brockwern@acponline.org.