Physicians are all too familiar with how state and federal regulations can bog down their day with unnecessary tasks that don’t help them provide better patient care.
But physicians need to know there are ways they can leverage policy changes to ease the amount of time they spend on the busywork that often stems from overinterpretation of regulations and contributes to burnout.
There are six things physicians can start doing right now to rid themselves of pesky tasks that distract from time they could be spending with patients, according to a playbook developed from the AMA “Debunking Regulatory Myths” series.
The AMA STEPS Forward® “Reducing Regulatory Burden Playbook” provides physicians and others with knowledge and resources to help alleviate these burdens and advocate for changes in their health systems. The playbook also aims to clarify often misunderstood and overinterpreted regulations and offers strategies to reduce administrative burdens that lead to additional work, excessive documentation, an increased cognitive burden and dysfunction within the health care team.
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.
Six ways to be proactive
Regulations can be challenging to interpret and when the interpretations are out-of-date, not aligned with current practice standards or designed for one practice setting but applied to another setting without any modifications the rules can create unnecessary patient care hazards and place burdens on physicians and other members of the care team.
Here are six things physician practices and health systems can start doing to reduce unnecessary burdens.
Start writing chronic medication prescriptions for the maximum allowed length of time. As the playbook puts it “90x4, call me no more.”
Laws and regulations governing prescription vary from state to state. In some states, the maximum time a physician can write a prescription for is 12 months, while others allow them to be written for 15, 18 or 24 months. When a patient has a chronic condition, writing a prescription can improve medication adherence, enhance patient-physician trust, reduce the stress of prescription expiration and lower the prescription processing burden for physicians.
Start adjusting EHR automatic logout time to fit the practice setting. “Keep me logged in,” the playbook says.
There are adjustable settings for the automatic logout time in an EHR system—the period of time after which the system logs out the user because there hasn’t been any activity. While the HIPAA Security Rule strongly recommends automatic logoff procedures, it doesn’t set a specific timeframe. When it’s appropriate, practices and health systems should consider automatic EHR logout times that vary with the work environment to help reduce how often physicians must login to the system.
Start new approaches to lighten the evaluation and management (E/M) documentation load. In other words, the playbook advises to “stop the note bloat!”
Start considering what is actually required for E/M documentation and explore ways that health care team members and help physicians with the task. Current Procedural Terminology (CPT®) updates in 2021 made the documentation simpler and more flexible for physicians and care teams. In addition, in 2019, the Centers for Medicare & Medicaid Services (CMS) changed its requirements to allow physicians to verify in the medical record any student, staff or patient’s documentation of components of these services rather than redocumenting the work.
No federal laws or regulations prohibit a clinically trained member of the health care team from assisting with documentation and other clinical duties during a patient’s encounter.
Start billing appropriately for preventive and problem-focused care. The playbook advises to “get paid for your work.”
CMS guidelines support—not prohibit—letting physicians bill for preventive and problem-focused E/M services when they are performed during the same appointment. Many physicians tend to under-code for their work. But accurately documenting all medically appropriate care and billing for what was done can help physicians be reimbursed for what is often significant amounts of uncompensated care.
Start involving other team members in order entry. “Share the care,” the playbook says.
“All types of personnel performing documentation assistance may, at the direction of a physician or another [licensed professional], enter orders into an EMR,” according to The Joint Commission’s statement on documentation assistance.
Further, no Medicare EHR incentive program requires Computerized Provider Order Entry. And federal regulations let clinical and administrative staff to pend or file orders based on a physician’s instruction, for example ones that are given verbally or thorough a written checklist, if it’s consistent with state requirements and institutional policies.
Start allowing verbal orders. “Just say it,” the playbook advises.
While CMS advises using infrequent verbal orders for medications and biologics in hospital, the organization doesn’t put limits on verbal orders in the outpatient setting. Physicians in Medicare-participating hospitals can use verbal orders and pre-printed and electronic standing orders, order sets and protocols.
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Why it matters
In addition to helping reduce burnout, ridding a practice of inefficiencies can help it become more effective and efficient. The savings can be calculated in real money.
For example, a change that saves one hour of physician time each day can save the practice or health system nearly $40,000 per physician per year. An online calculator from the AMA can help determine what the cost savings would be for a practice.
Reducing burnout also translates to dollars saved. In 2019, one study estimated that the conservative cost of burnout-related physician turnover and reduced clinical hours in the United States was $4.6 billion. An online calculator from the AMA can help determine an organization’s costs associated with physician burnout.
The AMA’s “Debunking Regulatory Myths” series aims to provide regulatory clarification to physicians and their care teams. It is part of the AMA’s practice-transformation efforts and provides physicians and their care teams with resources to reduce guesswork and administrative burdens so their focus can be on streamlining clinical workflow processes, improving patient outcomes and increasing satisfaction.
AMA STEPS Forward open-access toolkits and playbooks offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These resources can help you prevent burnout, create the organizational foundation for joy in medicine and improve practice efficiency.
