Source: AAFP News February 8, 2017, © American Academy of Family Physicians
As President Donald Trump turns his attention to reducing federal regulations, the American Academy of Family Physicians is asking him to take a close look at the cumbersome administrative tasks that family physicians struggle with every day.
The AAFP sent President Trump a strongly worded letter on January 31 that details how the depth and breadth of government regulations are making the practice of medicine more burdensome for family physicians. To help turn things in the right direction, the Academy included a proposal for reforms.
“There is not a single discipline of medicine that faces greater administrative and regulatory burden than family physicians and other primary care physicians,” the Academy wrote in the letter, which was signed by President John Meigs, MD. “In fact, research referenced in this letter shows that family physicians face a regulatory burden that is unmatched among the various medical disciplines.”
The letter cited a study published Dec. 6 in the Annals of Internal Medicine that found physicians typically spend 49% of their time on administrative activities and just 27% on clinical face time with patients.
“For every hour a primary care physician spends in direct patient care, they spend two hours engaged in administrative functions,” the letter noted.
The AAFP’s detailed proposal called attention to specific regulations the White House and Congress should change or eliminate to facilitate improved patient care, including those dealing with mandatory translation services, alignment of quality measures, chronic care management and transitional care management. Some of this burden has been added to physicians’ daily load recently, while other frustrations have been around longer.
“Compounding our members’ frustration is the simple fact that many of these regulations contribute nothing to their efforts to provide high-quality care to their patients,” the AAFP wrote in the letter. “This is why family physicians have grown so frustrated with the current administrative and regulatory requirements that are crushing physician practices, especially solo and small independent practices.”
The most vexing of these administrative burdens is the need to obtain prior authorizations. The AAFP is seeking the elimination of prior authorizations for generic drugs, a reduction in the number of products and services that require authorization, and creation of a single prior authorization form that all Medicare Part D plans would be required to use.
“Since a majority of family physician practices have contractual relationships with seven or more payers, they must often navigate seven or more different prior authorization rules and forms,” the proposal pointed out.
Another high-priority recommendation urges the Centers for Medicare and Medicaid Services (CMS) to drop all documentation guidelines for evaluation and management codes 99211-99215 and 99201-99205 for primary care physicians. These codes were created 20 years ago and no longer reflect the needs of physicians focused on coordinated care or clinical decision-making.
The AAFP also said CMS should delay implementation of appropriate use criteria requirements to 2019 so the program can be aligned with the Medicare Access and CHIP Reauthorization Act (MACRA) or, preferably, be eliminated entirely. Now that MACRA emphasizes payment for value-based care, the need for appropriate use requirements is obsolete.
In addition, the AAFP forcefully spelled out how technology is proving to be a hindrance to physician practices.
Electronic health records (EHRs) are supposed to facilitate communication between physicians and payers, but as family physicians well know, clumsy design makes them difficult to use and drains physicians’ time away from patient care. Adding to the problem, most EHR vendors have chosen not to make their systems compatible with competing products.
“Based on data from surveys the AAFP and others have conducted, the current health information technology infrastructure and products are neither efficient nor effective in supporting practice transformation,” the proposal stated.
Many EHR systems lack the kind of functionality that would help physicians manage larger population health issues, supervise care coordination and provide continuity of care.
Most frustrating to physicians, any shortcomings of EHRs become problems of the physician, not of the software company that designed a flawed system, a situation the AAFP said should change.
“We call on the U.S. Department of Health and Human Services to place the burden of compliance on EHR vendors and not on physicians,” the proposal urged. “EHR vendors must be held accountable for the inadequate design and poor performance of their products, not the physicians who struggle to use these products in their practices.”