Drowning in paperwork

This article appears in the 4/25/18 issue of Medical Economics.

The biggest problem plaguing primary care is the paperwork burden, according to Medical Economics’ 89th Physician Report, with 79 percent of respondents ranking it as their top challenge. 

“Payers and CMS with their reporting requirements are trying to do the right thing and reward quality care, but the process and metrics we have today are adding to the burden with little substantive evidence it is helping quality,” says David Gans, MHA, senior fellow of industry affairs for the Medical Group Management Association. 

With quality metrics becoming more common and the quantity of forms and data reporting increasing, experts say physicians need to take steps to keep their paperwork to manageable levels.

Start with the EHR

While large organizations typically have dedicated staff members to help with quality reporting requirements and the technology needed to make it minimally intrusive, small practices will have to invest time to save time, says Gans. He suggests starting with the EHR.

“Physicians can work with their EHR vendor to look at ways to automate data reporting, such as having the right prompts appear during a visit that address quality metrics,” Gans says. For example, if a patient has diabetes, it might prompt about foot or eye exams, document it, and report it to the practice’s contracted payers. 

Jennifer Caudle, DO, a primary care physician and associate professor at Rowan University School of Osteopathic Medicine, says that physicians don’t always realize all the help that may be available through their EHR. “Sometimes taking a refresher course can be helpful in reminding us of tips and tricks to more efficiently use the program,” she says. “Doctors might be surprised at how many reminders and alerts can be set up in the EHR.”

Because of the number of patients covered by Medicare, most EHRs should offer some help reporting to CMS. But Gans points out that this assistance may be built-in or an add-on capability. Software modules designed for private payers are rarer because insurers reporting requirements can vary by state or region, making it expensive for EHR vendors to design custom software for each area of the country for each payer.

Physicians should also review how their EHR desktop view is set up and how information is organized there, then customize it to reflect their workflow, she adds. To save time, she structures her view to show tasks and what her day looks like and what reports need to get done.

“Having a strategy for the EHR is very important,” says Caudle. “The small things should not be underestimated.”

Stay focused

Many distractions can prevent a doctor from focusing on priorities, and experts say developing a strategy to deal with them can help manage the paperwork burden in several ways.

For example, medical scribes not only free up physicians to spend more time interacting with patients instead of a computer, they can also help document information needed for quality reporting.

“If you are working with a scribe, part of their responsibility would be to record information about what the physician is doing that mirrors quality metrics or prompt them to ask the right questions,” says Gans. 

Caudle suggests turning off cell phone alerts so as to not lose time constantly checking emails or texts. Instead, set aside a specific time to deal with all messages for the day or have someone screen the messages for anything urgent.

Practices can also help doctors focus on patients instead of paperwork by having a simple in-house fax protocol whereby a designated front-office person picks up faxes each hour from physicians or deals with requests they have for retrieving information. 

 “I do think it’s important that physicians don’t get caught up in the faxing, scanning, and calling. If you are able to ask someone to do this and it is within their responsibilities and skill level, that will free up physician time for more appropriate tasks,” says Caudle.

She adds that sometimes it’s a matter of delegating tasks and working only at the top of a license. “Physicians need to recognize that and work with their team,” she says. “They need to ask themselves, ‘What is the best and most appropriate use of time?’”

Gans says that even though CMS is reviewing reporting requirements, physicians should not assume that value-based care-and the reporting that goes with it-is going away, and recent announcements from the agency have reaffirmed that.

“In the long run, value-based reporting is going to be a requirement from all payers,” he says. “Doctors need to build systems into their normal practice workflow while taking advantage of the capabilities that may be available from their EHR. They need to know what their systems can do to record information, how they can report data and make sure they understand all the requirements and deadlines.”