Unnecessary password revalidation, documenting unneeded information and some other needless tasks may seem small, but they add up over the course of a day, week or year. And that burden on physicians’ workload contributes to burnout.
A playbook developed by the AMA gives physicians and others the knowledge and resources to help alleviate these burdens and advocate changes in their practices or health systems. That includes a list of six things that physicians and their organizations can drop right now to help ease the workload.
The AMA STEPS Forward® “Reducing Regulatory Burden Playbook” 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.
“Many physicians, especially those already experiencing burnout, feel resigned to doing whatever work they are given. But with commitment from leaders, concrete examples to start from, and processes to evaluate and implement effective changes, unnecessary work does not have to be ‘just how it is,’” the playbook says.
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™.
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. Saving one hour of support team time each day can lead to a $13,000 savings per person 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.
6 things to stop now
A physician may not have direct control over specific policy requirements, but they can ask pointed questions about them and work with practice and organizational leaders to pursue changes.
Physicians should work with legal and compliance professionals, IT team members and clinical, administrative and executive leaders to de-implement unnecessary tasks at the practice or organizational level. Based on research the AMA has done as part of its “Debunking Regulatory Myths” series, here are six things that physician practices, hospitals and health systems can stop doing now.
Unnecessary EHR password revalidation and two-factor authentication for approving or signing orders. “One password is enough,” says the playbook.
Some organizations require a password reentry, badge tap, biometric identification or challenge questions for approving or assigning orders. Turning this off can potentially save billions of clicks and keystrokes. When it comes to federal regulations for approval of a prescription for a non-controlled substance, none requires a two-factor authentication in an EHR.
Routing results of tests ordered by others to the EHR inbox of the patient's primary care physician. The motto, says the playbook, should be “you order it, you own it.”
No regulatory agency requires that practices route all patient test results to the primary care physician. On top of that, sending results to multiple physicians can create a patient safety hazard because of confusion over who is responsible for reviewing, communicating and acting on a test result.
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Routing thank-you patient portal messages to physician EHR inboxes. On this policy, physicians should say “thanks, but no thanks.”
There is no regulatory obligation to respond to every patient portal message, so reducing the number of messages that have little or no clinical value is important. A number of practices have suppressed the system from delivering thank-you messages—replies from patients that express gratitude or acknowledge understanding but require no further action—to reduce unnecessary messages in the clinician inbox.
Documenting information that is not medically necessary. “Stick with the vital vitals,” says the playbook.
Regulatory requirements do not spell out a certain number of vital signs that must be included in an ambulatory encounter documentation. Including only the history and objective data pertinent to the care delivered during a specific patient encounter can help reduce unnecessary work for physicians and their clinical teams. For example, a patient with diabetes or hypertension who is in for a follow-up visit and doesn’t have symptoms of an acute infection does not need a temperature check.
Routing patient-event notifications directly to physician EHR inboxes. The Centers for Medicare & Medicaid Services (CMS) says practices and health systems may develop internal processes to prioritize and tailor how event notifications are handled to, among other things, reduce redundancy. So, admission, discharge and transfer (ADT) reports aren’t required to go directly to a physician’s inbox.
Asking questions about past mental health history on credentialing applications. Just “don’t go there,” says the AMA playbook.
Neither The Joint Commission nor the Federation of State Medical Boards requires that licensing and credentialing organizations such as state licensing boards, physician credentialing services and professional liability insurance carriers ask probing questions about physicians' past mental health, addiction or substance use history on licensure and credentialing applications. In fact, they strongly discourage it.
Other time-wasting myths you should know
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.
Physicians are encouraged to submit questions or ideas they have about potential regulatory myths. The AMA’s experts will research the matter. If the concern turns out to be a bona fide regulation that unnecessarily burdens physicians and their teams, the AMA’s advocacy arm can get involved to push for regulatory change.
