Health care is ever-changing, but one barrier persists: administrative burdens. In fact, 20% of health care professionals have left the workforce since the start of the pandemic, and it costs the U.S. health care system $26.7 billion in labor to do prior authorization. Administrative tasks continue to grow and divert physician and staff time away from clinically important activities, such as providing care to patients. These tasks also cause burnout among health care professionals, increase the cost of care, and impact patient access to care.
ACP is continually working to identify and prioritize the most burdensome administrative tasks faced by its members and their patients. Recently, the College distributed a survey to members of several ACP committees asking what types of administrative burdens they face in their practices. Respondents identified prior authorizations, electronic health records (EHRs), and prescribing drugs as the top three burdens. As ACP expands our resource center to provide guidance and tools for health care professionals to overcome these burdens, we wanted to provide some quick solutions you can use now.
Prior authorization causes major delays in delivering patient care, especially when requests are not complete or incorrect information is submitted to the health plan, resulting in denials. Training staff to complete all prior authorization requirements can not only free up the clinician's time but also help avoid mistakes that often lead to denials. Because delays due to prior authorization affect treatment as well as patient adherence, educating patients about prior authorization and coverage limitations within their insurance is important. This allows patients to advocate directly with their insurance regarding prior authorization for their ongoing treatments.
EHRs have transformed the way our world operates but lead to additional burdens. Yes, EHRs are expensive, require extensive training, and like all technology can have glitches, such as systems not communicating with each other. However, when configured and used correctly, EHRs can ease physician burnout. To reduce the amount of time spent on the computer, physicians can hire scribes and train staff to enter data, document visits, and perform other similar tasks. These strategies allow the physician to focus on patients' needs and allow data to be documented accurately. Using electronic prior authorization systems is another way to standardize the process and ease administrative burdens for physicians who currently use different data, formats, and procedures to process prior authorization requests.
Prescribing drugs is another burdensome activity for clinicians. Identifying safe and effective yet cheaper alternatives to high-cost prescription drugs, such as generic brands, usually does not require prior authorization, although it may require speaking with a pharmacist. Clinician or clinical staff can work with the patient's care team (family member, nurse, pharmacist, physician, etc.) to determine which medications the patient is taking at which dosage and frequency and create a consolidated list. Such medication reconciliation can reduce medication errors and improve patient safety. Synchronizing and standardizing recurring patient prescriptions should be a common practice if possible. This means determining which drugs used for chronic conditions can be prescribed for 90 days with three refills, saving time for both your team and your patient. Last, having open communication with pharmacies can help physicians understand prior authorization requirements. Understanding which medications require prior authorization and entering concise, complete information when prescribing medication can eliminate denials and disruptions to the practice workflow.
ACP routinely engages in ongoing outreach and stakeholder engagement efforts with external sources of administrative and regulatory burden. ACP has also developed significant policy recommendations and hosted webinars to address these administrative tasks. “Putting Patients First by Reducing Administrative Tasks in Healthcare: A Position Paper of the American College of Physicians” was published May 2, 2017, in Annals of Internal Medicine. The webinars “Breaking Bad! Prior Auth Harms the Physician-Patient Relationship” and “How to Avoid Peer-to-Peer Calls” are available online. For more information about ACP's work addressing administrative burdens, go online.