1. Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians March 30, 2017 ACP Medical Practice & Quality Committee Chair, Robert McLean, M.D., FACP

2. Disclosure of Financial Relationships
Robert McLean, M.D., FACP
Has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Practicing Internist/Rheumatologist Northeast Medical Group of Yale New Haven Health System Medical Director of Clinical Quality New Haven, Connecticut

3. We’re All Crazy…

4. Everyone talks “Hassle Factor”

5. Strangling in Red Tape

6. 1990 Definition of Hassle Factor from ASIM
The increasingly intrusive and often irrational administrative, regulatory review and paperwork burdens being placed on patients and physicians by the Medicare program and other insurers.

7. Goal of policy paper Analytic approach Defining administrative tasks
Comprehensive, cross-cutting approach
Identifying Consequences
Recommendations to reach solutions

8. Paper Outline Framework for analyzing administrative tasks
Sources: External vs Internal
Intents of the tasks
Impacts of the tasks
Solutions

9. Figure 1: A Framework for Analyzing Administrative Tasks

10. External Sources of Administrative Tasks
Public and Private Payers
Government Entities and Oversight
Oversight by Private Entities
Vendors and Suppliers
Other Healthcare Organizations
Measurement of Patient Experience and Evolving Consumer Experience
1-payments, appeals, prior-auths, referral processes, quality measurements
2- Medicare specific-PQRS, Meaningful use—now the MACRA Quality Payment Program; E&M coding requirements, HIPAA rules, OSHA standards for medical offices
3- certification boards, accreditation agencies (NCQA, TJC)
4-EHR vendor issues, DME companies with documentation requirements
5-Home Health Agencies with order forms
6- Dealing with surveys, patients need forms (disability, FMLA)

11. Internal Sources of Administrative Tasks
Inefficient Workflow
Lack of Effective Team- based Care
Inability to use Technology Effectively and Efficiently

12. Intents of Administrative Tasks
Provision of Payment
Ensuring Care is High-Quality & Safe
Reduction of Excess Utilization, Fraud & Abuse
Ensuring Financial Security & Profit for the Entity
Lacking Clear Intent

13. Sidebar: Responsibility as Stewards
Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.
-ACP Ethics Manual

14. Impacts of Administrative Tasks
Billing & Insurance- Related Activities
Measurement & Reporting Impacts
EHR/Health IT Impacts
Impact on Clinical & Patient Care
Impact on Physician Satisfaction -Burnout
1-estimates 3-5 hrs/wk, cost impact $68-85K per yr per FTE
2- one study 15 hrs/wk per MD & staff for dealing with external quality measures
3-many additional hours
4- more time with computer than with patient

15. Solutions
With classifying the Whats and Whys, we can more clearly provide solutions…

16. ACP Policy Recommendations:
Solutions Continued…
ACP Policy Recommendations:
Stakeholders who develop or implement administrative tasks should provide financial, time, and quality of care impact statements for public review and comment.
Tasks that cannot be eliminated must be regularly reviewed, revised, aligned and/or streamlined with the goal of reducing burden
Stakeholders should collaborate to aim for performance measures that minimize unnecessary burden, maximize patient- and family-centeredness, and integrate measurement of and reporting on performance with quality improvement and care delivery
Stakeholders should collaborate in making better use of existing health IT, as well as develop more innovative approaches.
As the US health care system evolves to focus on value, stakeholders should review and consider streamlining or eliminating duplicative administrative tasks
Rigorous research is needed on the impact of administrative tasks on our health care system
Research on and dissemination of evidence-based best practices to help physicians reduce administrative burden within their practices and organizations

17. Figure 2: Taxonomy of Administrative Tasks External to the Practice & Health Care Environment
Legend: Each circle indicates a characteristic of an administrative task
Administrative tasks in these categories are worthwhile
Administrative Tasks in these categories require careful consideration of alternatives ?
Administrative tasks in these categories should be eliminated
- This figure illustrates Policy Recommendation #1 - Stakeholders who develop or implement administrative tasks should provide financial, time, and quality of care impact statements for public review and comment.