Top Challenges Number 1: Administrative burdens

It has never been such a challenging time to be a physician. Every physician, whether they own their own practice or are employed by a hospital or larger health system, must navigate a host of obstacles each and every day: Payment hassles, staffing issues, patient communication obstacles, technology burdens, long hours and burnout, and much more. 

Each December, Medical Economics presents its list of the top challenges facing physicians going into the next year. This year we focused not only on the challenges, but also practical tips physicians can start using right away to make practicing easier.

Challenge 1: Administrative burdens

Physicians are increasingly beset by paperwork, administrative hassles and regulatory burdens-and that trend will not abate in 2020. Prior authorizations, quality metrics and other complex challenges are keeping physicians up at night with worry, reducing the time they spend with patients and leading to a surge of physician dissatisfaction.

In August, Medical Economics asked physicians what issues were affecting their career satisfaction, and more than 37 percent said “too much paperwork and government/payer regulations.” That was the most common answer, ahead of EHRs, poor work-life balance and declining reimbursement.

“What we hear from doctors repeatedly is, ‘I went into healthcare to help people, but I spend my day typing into a computer or on the phone doing prior authorizations and I feel like my time is being wasted on all of these things instead of focusing on taking care of my patients,’” says Clif Knight, MD, FAAFP, a board member of the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience, a group fighting burnout in healthcare. “And over time doctors lose that connection of why they went into medicine and start wanting to do something else because they feel like they’re just wasting their time.”

These challenges lack easy solutions, but there are strategies physicians can put in place to lessen the burden. One of physicians’ biggest complaints is how much time prior authorization consume in the daily schedule of the practice. According to Medical Economics 2019 Physician Report, physicians spend nearly an hour per day on prior authorizations, while staff members spend an additional 12 hours per week dealing with payer approvals.

Red tape and hassles also don’t vanish for employed physicians, so employed physicians often trade one type of administrative burden for others.

“When you become part of a large system, you’re no longer a self-employed person who can determine their own work or call schedule,” says Robert McLean, MD, FACP, president of the American College of Physicians. “A lot of those little decisions you used to make [as a practice owner] while they could become headaches, they also contribute to the feeling that you’re a self-actualized person, and that gets lost as an employee.” 

9 ways to ease the prior authorization burden

1. Be prepared.

Have forms available, either in print or on computers, for the procedures and prescriptions that most commonly require prior auths.

2. Use the Web.

Check the payer’s website for any prior auth criteria they have posted, and submit requests using the site rather than by telephone.

3. Make the patient’s records available.

Be sure the staff member submitting the prior auth request has access to the patient’s chart and any other information needed to justify the request.

4. Document the need.

Note in the patient’s chart why they need a particular procedure, medication or exception to the payer’s requirement.

5. Follow guidelines.

Following recommended treatment guidelines increases the likelihood that a payer will approve the request.

6. Learn what drug payers will cover.

Knowing which medications all your payers cover for common conditions and prescribing them when appropriate reduces the need for authorizations.

7. Centralize the process.

Designate specific staff members to handle prior authorization requests, even if your practice has more than one site. Then make sure those individuals have access to all patient records and providers’ notes.

8. Do a cost-benefit analysis.

Find out how many prior authorizations each of your biggest payers required over the last year and consider dropping any whose reimbursements don’t justify the time.