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 continues to urge 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:

• Reforming Evaluation and Management (E/M) documentation guidelines, through a multi-stakeholder process that includes CMS, practicing physicians, and their professional organizations, to reduce burden and improve the value of clinical notes. ACP was a leader, along with several other specialty societies, in creating a coalition to push to improve payments for the historically undervalued E/M services as well as reduce E/M documentation burden. CMS recently accepted the work of the coalition and finalized significant updates to the E/M documentation guidelines that allow for more flexibility in how physicians can document for a certain level of service. These changes are a positive step towards reducing note bloat, and ACP has established both a task force and advisory group focused on leveraging these regulatory changes in the service of improving documentation clarity and value, decreasing documentation burden, and furthering EHR usability, interoperability, and better care.
   
• 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 maintains ongoing outreach to the various sources of administrative tasks (e.g., regulators, EHR vendors, medical device manufacturers, etc.) to discuss policy and establish next steps for future collaboration.  After ACP’s outreach, CMS began two initiatives of their own—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 the Medicare Red Tape Relief project, as proposed by the House Ways and Means Committee.  ACP intends to participate in the project moving forward and continue to provide feedback to Congress on their oversight of the 21st Century Cures implementation and efforts to improve health IT interoperability and patient access to data.

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.