Philip Eskew, DO, JD, MBA; Member, ACOFP Federal Legislation and Advocacy Committee
The current volume of required documentation is a daily contributor to mental fatigue and job dissatisfaction for many family physicians. Spending non-reimbursed, expected time navigating a patient’s complicated history is challenging enough. Osteopathic family physicians should not need the skills of a software engineer to navigate a third party driven electronic medical record (EMR) interface. Unfortunately, we are not the end user of the EMR (and neither is our patient). The end user is the third party payor, for whom it was designed.
Whether we are checking a box for a quality metric that should not apply to our patient or find ourselves attempting to explain to a third party payor lacking medical training why a particular intervention is necessary—stressors all add up. Direct primary care (DPC) physicians are fortunate in not having to spend as much time on these types of particular third party inefficiencies. Some administrative inefficiencies are still faced by all providers. Let’s focus on three examples and what you can do to reduce stressors.
What do you do when your patient asks you to fill out prior authorization paperwork?
- Consider asking the patient to remain in the room with you during the entire process.
- Consider recording the phone call.
- Consider requiring that the third party payor or patient reimburse you for doing their time-consuming, required work. You can access sample forms or watch this video to learn more about this approach. Neither will likely pay the provider, but future requests for similar items may be discouraged.
What if your patient is having difficulty acquiring a cash price for a procedure, durable medical equipment, radiologic testing or a referral?
It is prudent to not spend time arguing with administrative workers at these other offices. Educate your patient about their Health Insurance Portability and Accountability Act rights as modified by the Health Information Technology for Economic and Clinical Health Act. Outside a few narrow circumstances all patients have a right to demand and receive cash pay pricing (even when they have insurance).
What if an insurance company is declining to pre-approve a requested radiologic study, imaging or procedure?
Demand a peer-to-peer call and request that your patient be present during the call, informing them that the patient is present. Explain things once via phone and then with a follow-up letter (copying to the patient) that explains why the intervention is necessary. If the request is denied there is no need to have a lengthy back and forth with the insurer. Now the patient has witnessed the exchange, and you can allow the patient to decide what to do next. The patient could:
- Appeal by following insurance company procedures,
- File a medical board complaint against the denying physician, or
- Seek legal action having an attorney contact the third party payor.
2022 ACOFP Principles of Healthcare System Reform: Reducing Unnecessary Paperwork Requirements
ACOFP recognizes that burdensome paperwork requirements are contributing to the physician shortage and are ultimately inhibiting appropriate and accessible patient care, and the call to reduce these unnecessary requirements is one of our 2022 Principles of Healthcare System Reform.
Federal programs from the U.S. Centers for Medicare and Medicaid Services (CMS) like the Medicare Quality Payment Program are intended to improve patient care while reducing spending but unfortunately have also increased the administrative burden on physicians. Other programs—such as the U.S. Centers for Disease Control and Prevention’s Patients Over Paperwork initiative and Meaningful Measures Framework—have attempted to reduce paperwork requirements, and the U.S. Health Resources and Services Administration—through the U.S. Department of Health and Human Services—announced plans to distribute funding intended to strengthen resiliency and address burnout in the healthcare workforce. Despite these measures, ACOFP believes more must be done.
In response to the desire to improve efficiencies to osteopathic family physicians, since late 2020, ACOFP has identified, monitored, and pursued advocacy opportunities, including the following, to address reducing burdensome paperwork requirements:
- Attended the CMS 2022 Quality Conference Session: Re-Envisioning Quality: A Cross-Federal Perspective, based on the CMS National Quality Strategy (April 12, 2022)
- Attended Senate Committee on Health, Education, Labor and Pensions (HELP), Subcommittee on Employment and Workplace Safety hearing: Recruiting, Revitalizing & Diversifying: Examining the Health Care Workforce Shortage (February 10, 2022)
- Attended House Energy and Commerce Subcommittee on Health hearing: Empowered by Data: Legislation to Advance Equity and Public Health (June 25, 2021)
- Submitted a comment letter on Proposed Modifications to the HIPAA Privacy Rule to Support, and Remove Barriers to, Coordinated Care and Individual Engagement (April 22, 2021)
- Submitted a comment letter on Calendar Year (CY) 2021 Physician Fee Schedule (PFS) and Quality Payment Program (QPP) proposed rule (October 5, 2020)
Hopefully, these activities will give physicians ideas on how to reduce burdensome documentation, alert and educate our elected officials about the difficulties associated with redundant/unnecessary paperwork, and demonstrate to our membership these problems, leading to possible resolution.