Top 8 worst administrative hassles according to physicians

Physicians, especially primary care physicians (PCP), often bear the brunt of what many consider to be excessive regulatory requirements associated with patient care. Here are the most common administrative burdens, according to physicians.  

Pre Authorization for Medications and Tests 

For PCPs, there can be a preauthorization catch 22, because payers often require a specialist order for approval of diagnostic tests, but the consulting specialist often wants to see the test results first, before seeing the patient. Nicole Price Swiner, MD, co-author of Thinking About Quitting Medicine, is a PCP in Durham, North Carolina.

“Paperwork is the bane of my existence,” Swiner says. As a PCP, she says that she is required to fill out requests for insurance companies to authorize everything her patients need, such as medications, procedures and consultations.

Managing Consults From Specialists

PCPs, in particular, experience roadblocks when it comes to obtaining and following up on specialty care for patients. Fabiola Antonelli, MD, an internist in Dallas, Texas, shares her experience with this problem.

“My consults are discontinued and denied multiple times, and I have to sign off on preauthorization templates for Lyrica, Plavix and many other specialist-ordered drugs that my patients need,” Antonelli says.

Patient Records

Doctors across specialties learned in medical school that the patient chart is a valuable record to be used for communication between physicians, nurses and all patient care providers. Dena Hubbard, MD, a pediatrician in Kansas City, says that in her experience, the requirements that need to be met in filling patient charts focuses on criteria that do not center on patient care.

“Charting for billing and coding are based on malpractice prophylaxis rather than communicating the details of patient care from one provider to the next,” Hubbard says.  

Next: Benchmarks

Benchmarks 

Benchmarks and institutional goals can certainly be reasonable methods of achieving improved patient care. Yet, one of the issues that doctors frequently bring up is that rigid, and sometimes odd benchmarks do not account for the realities of caring for human beings. One-size-fits-all targets are seen as getting in the way of patient wellness instead of improving it. 

For example, Hubbard says that doctors are given a target percentage when it comes to getting mothers to breastfeed their babies.

“This is a woman’s choice and not all mothers can breastfeed, due to maternal illness, medication or low production. Yet mothers are harassed, and doctors are dinged for not meeting breastfeeding goals,” she says.

Hubbard also sheds some light on how benchmarks are one of the contributors when it comes to the overuse of opioids.

“Mandating pain control as a fifth vital sign with an unrealistic goal of getting pain to zero ends up causing physicians to prescribe more narcotics to comply with regulations,” she says. 

Too Many Alerts 

PCPs send patients for lab tests and diagnostic imaging at laboratory facilities, imaging centers and nearby hospitals. The laboratory facilities and hospital systems have moved to automated alerts as a way to prove that responsible parties have been notified of a variety of problems, ranging from a dangerously prolonged prothrombin times to marginally low platelet counts. PCPs receive numerous notifications and alerts, which can lead to a “boy who cried wolf” phenomenon.

Antonelli says that she sometimes receives hundreds of automated alerts per day about things she has not ordered and is not actively monitoring because the automated system is programmed to notify every provider involved in a patient’s care. 

Administrative Delays and Mistakes 

Despite the effort and time involved in abiding by administrative rules, doctors can find themselves frustrated when the administrative side does not comply with its own rules. For example, Virginia Moreno-Thornley, MD, a neurologist in New York City, says that in order to get approval for medications for multiple sclerosis, she is required to provide information about previous medications, length of time, dosages and side effects.

 She has frequently discovered that the submitted paperwork was lost or never processed, and then she repeats the process all over again. She says that she has asked her patients to call back every day, has left notes to herself to follow-up regularly, and has had to wait months for a response. 

Next: Solutions

Solutions

Kate Tulenko MD, a pediatrician based in Alexandria, Virginia, has found that medical scribes can help in alleviating some of the burden. Medical scribes are usually students aspiring to be nurses or physicians. “Medical scribes accompany the physician on patient interactions and document in the electronic medical record. Scribes can also do billing and make calls to insurance companies-two other administrative tasks that slow down physicians,” she says.

Farhan Ali, MD, an internist in Baltimore, Maryland, suggests that doctors who look at the big picture by understanding the business model of medicine can learn to benefit from some of the administrative steps.

“Doctors are trained in hypothetical, ideological patient care scenarios, so it is hard for us to accept the administrative requirements. Administrators work for different objectives, which is real life,” he says. But, he also feels that the administrative burden has gone too far. “There are two sides of the story, one is that doctors need to recognize the financial practicality of patient care and the other is that administration has to be limited,” Ali says.

From the Administrative Side

A New Jersey physician who does peer-to-peer reviews, and who did not give permission to use her name, says that her work is often slowed when the requests come to her with no information or with information that is not relevant to the test or to the drug being requested.

“We all have administrative hassles, maybe we can learn from each other,” she says.

Phillip Snider, DO, a family physician in Virginia Beach, Va., is also Senior Lead Physician, Bon Secours-Enterprise, and spends about half of his time in patient care and the other half on the administrative side.

“I see the ‘why’ behind all the extra alerts and messages,” Snider explains. He has some advice for practicing physicians as they try to navigate the complicated and frustrating administrative hassles. “Be prepared to make a request of the other person. If they say ‘no’ just ask what's behind their answer-what needs of theirs aren't getting met by that particular strategy-and be ready to create a solution from that point,” Snider says.