Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians March 30, 2017 ACP Medical Practice & Quality Committee Chair, Robert McLean, M.D., FACP

Disclosure of Financial Relationships Robert McLean, M.D., FACP Has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Practicing Internist/Rheumatologist Northeast Medical Group of Yale New Haven Health System Medical Director of Clinical Quality New Haven, Connecticut

We’re All Crazy…

Everyone talks “Hassle Factor”

Strangling in Red Tape

1990 Definition of Hassle Factor from ASIM The increasingly intrusive and often irrational administrative, regulatory review and paperwork burdens being placed on patients and physicians by the Medicare program and other insurers.

Goal of policy paper Analytic approach Defining administrative tasks Comprehensive, cross-cutting approach Identifying Consequences Recommendations to reach solutions

Paper Outline Framework for analyzing administrative tasks Sources: External vs Internal Intents of the tasks Impacts of the tasks Solutions

Figure 1: A Framework for Analyzing Administrative Tasks

External Sources of Administrative Tasks Public and Private Payers Government Entities and Oversight Oversight by Private Entities Vendors and Suppliers Other Healthcare Organizations Measurement of Patient Experience and Evolving Consumer Experience 1-payments, appeals, prior-auths, referral processes, quality measurements 2- Medicare specific-PQRS, Meaningful use—now the MACRA Quality Payment Program; E&M coding requirements, HIPAA rules, OSHA standards for medical offices 3- certification boards, accreditation agencies (NCQA, TJC) 4-EHR vendor issues, DME companies with documentation requirements 5-Home Health Agencies with order forms 6- Dealing with surveys, patients need forms (disability, FMLA)

Internal Sources of Administrative Tasks Inefficient Workflow Lack of Effective Team- based Care Inability to use Technology Effectively and Efficiently

Intents of Administrative Tasks Provision of Payment Ensuring Care is High-Quality & Safe Reduction of Excess Utilization, Fraud & Abuse Ensuring Financial Security & Profit for the Entity Lacking Clear Intent

Sidebar: Responsibility as Stewards Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available. -ACP Ethics Manual

Impacts of Administrative Tasks Billing & Insurance- Related Activities Measurement & Reporting Impacts EHR/Health IT Impacts Impact on Clinical & Patient Care Impact on Physician Satisfaction -Burnout 1-estimates 3-5 hrs/wk, cost impact $68-85K per yr per FTE 2- one study 15 hrs/wk per MD & staff for dealing with external quality measures 3-many additional hours 4- more time with computer than with patient

Solutions With classifying the Whats and Whys, we can more clearly provide solutions…

ACP Policy Recommendations: Solutions Continued… ACP Policy Recommendations: Stakeholders who develop or implement administrative tasks should provide financial, time, and quality of care impact statements for public review and comment. Tasks that cannot be eliminated must be regularly reviewed, revised, aligned and/or streamlined with the goal of reducing burden Stakeholders should collaborate to aim for performance measures that minimize unnecessary burden, maximize patient- and family-centeredness, and integrate measurement of and reporting on performance with quality improvement and care delivery Stakeholders should collaborate in making better use of existing health IT, as well as develop more innovative approaches. As the US health care system evolves to focus on value, stakeholders should review and consider streamlining or eliminating duplicative administrative tasks Rigorous research is needed on the impact of administrative tasks on our health care system Research on and dissemination of evidence-based best practices to help physicians reduce administrative burden within their practices and organizations

Figure 2: Taxonomy of Administrative Tasks External to the Practice & Health Care Environment Legend: Each circle indicates a characteristic of an administrative task Administrative tasks in these categories are worthwhile Administrative Tasks in these categories require careful consideration of alternatives ? Administrative tasks in these categories should be eliminated - This figure illustrates Policy Recommendation #1 - Stakeholders who develop or implement administrative tasks should provide financial, time, and quality of care impact statements for public review and comment.