What could your practice do with an extra two hours a day?
That’s the question Marie Brown, MD, an internist and director of practice redesign at the AMA, has for physicians who may be skeptical about implementing synchronized annual refills for patients on chronic medications.
“If you think about the waste in the system and the fact that so many of our patients are on long-term medications—lifelong medications—the amount of time spent on refills is enormous,” Dr. Brown said during an episode of the “AMA STEPS® Forward Podcast” with Jill Jin, MD, MPH, an internist and senior physician adviser for the AMA.
Synchronized prescription refills for chronic medications—other than controlled substances—are handled yearly. Prescriptions are written for 90 days, with four refills, and are renewed at the same time each year. Ideally, the prescribing corresponds to the patient’s annual wellness visit.
During the podcast, Drs. Brown and Jin discussed how to transition to synchronized annual refills so that patients can get their medication prescribed with fewer refill requests for physicians.
Emphasize time saved
Even just writing annual prescriptions without synchronization results in significant time savings and reduction in burden on physicians. That in turn can help reduce physician burnout.
“Instead of 90 with one refill, making it 90 times four can save … half the refill requests in a year—so, immediately cutting down by 50% phone calls, faxes, inbox messages,” Dr. Brown said.
The change also can save patients time in reducing trips to the pharmacy, which may in turn improve medication adherence and their care. This is important because the average person older than 65 is taking three to six prescription medications a day. For patients older than 75, many are taking more than five prescription medications a day.
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
That includes AMA STEPS Forward open-access toolkits, which 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.
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Answering the what-if’s
Dr. Brown said the skeptics among physicians tend to think of exceptions in which it would be potentially harmful to provide yearlong prescriptions. For example, the fear that some patients will avoid visits if they do not need refills.
But with the two hours a day saved, care teams can put together a failsafe process to reach out to that patient, said Dr. Brown. This is also where pre-visit planning can help. Before the patient leaves, they make an appointment for their next visit—whether it’s three or six months from now. And if a patient misses an appointment, there is a fail-proof process in place thanks to those hours saved each day.
“I was the skeptic. I read this and I thought, sounds wonderful, but will my patients come back in six months?” Dr. Brown said. “I was very skeptical and very pleasantly surprised because in as short a period of time as six months, I had an extra hour of time freed per day. My nurse had an extra hour. It was easy to reach out and put in place the process … if a patient missed an appointment.
“And for those patients who you think might miss, then don't do it for them,” she added, noting “that was a very small percentage of my total patient panel.”
“This 90 times four doesn't have to be for everybody,” Dr. Jin said. “As a doctor, you can still choose which patients you want to mark as an exception and not do that for. But again, we're looking at what is the way to save most physicians and most patients the most amount of time.”
