Top Challenges 2021: #1 Administrative burdens and paperwork

If doctors had to chart their feelings about practicing medicine, many would list “paperwork” as their chief complaint.

In countless surveys and studies, and across specialties, physicians consistently cite the time and energy they must devote to filling out forms and other administrative tasks near or at the top of their list of grievances. The mantra repeatedly heard throughout the profession is, “This isn’t why I went into medicine.”

The problem is worsened by electronic health records (EHR), now used by close to 90% of office-based physicians. Once seen as a way to streamline documentation data sharing, EHRs instead have become enormous time-sucks. A December 2016 study in Annals of Internal Medicine found that physicians in outpatient settings spent about 27% of their day on direct clinical face time with patients, but 49% on EHRs and desk work. Many also worked up to two hours every evening on EHR-related tasks.

More recently, the proliferation of quality metrics physicians must document, while well-intentioned, has resulted in another layer of time-consuming administrative tasks for doctors and their staffs.

“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 evidence it is helping quality,” David Gans, MHA, senior fellow of industry affairs for the Medical Group Management Association, told Medical Economics®.

The growing number of treatments and medications requiring prior authorizations from payers are yet another source of administrative frustration for doctors and their staffs. In a 2020 American Medical Association survey, 86% of respondents described the administrative burden of prior authorizations as “high or extremely high.”

Similarly, respondents to the Medical Economics® Physician Report said prior authorizations consumed, on average, more than 16 hours per week of practice time, including 11.6 hours for staff members and 4.6 hours for themselves.

Paperwork and administrative requirements are also linked to the alarming increase in physician burnout rates, especially among primary care doctors. When Medical Economics® recently asked doctors what contributed most to their feelings of burnout, 31% cited “paperwork” — more than twice the percentage of the second-leading cause, poor work-life balance.

“The data show that the things that cause burnout are the things that get in the way of why you went into medicine in the first place, such as being able to provide the kind of care you want to provide to your patients,” Jack Resneck, M.D., immediate past chairman of the American Medical Association board of trustees told Medical Economics®in an interview this year.

Fortunately, there are steps physicians can take to reduce their administrative burden, starting with the EHR. Gans suggested that doctors and practices work with their EHR vendor on ways to automate data reporting, such as tailoring prompts according to patients’ specific requirements. For patients with diabetes, for example, the EHR might be programmed to provide reminders of the need for foot and eye exams, and report to payers that the patient received the reminder. In addition, some EHRs now offer the option of automatically reporting some quality data to CMS.

Employing scribes can also help to reduce paperwork and other administrative burdens. A 2018 study in JAMA Internal Medicine concluded that their use was associated with significant reductions in EHR documentation time and “significant improvements in productivity and job satisfaction.”

Ultimately, however, doctors probably need to accept that paperwork and administrative tasks will be an inescapable part of practicing medicine — particularly with the spread of value-based care models, which usually require detailed tracking and reporting of quality metrics.

“In the long run, value-based reporting is going to be a requirement from all payers,” Gans predicts.