Every so often over a number of years, Ohio family physician Kevin Hopkins, MD, would ask why he and his colleagues were required to use password revalidation in their EHR when signing ambulatory orders for noncontrolled medications.
He was told that the state pharmacy board required it. That was true for years—until it wasn’t. When Dr. Hopkins followed up again in 2022, administrators discovered that requirement had, unbeknownst to clinic decision-makers and others around the state, been sunset sometime in 2021.
When Dr. Hopkins’ health care organization, the Cleveland Clinic, stopped requiring the password revalidation for noncontrolled medication in January 2023, it affected 11 million orders annually. The move saved physicians more than 12,000 hours, saved an estimated $2 million a year, and ditched a clerical task that added to the burdens that drive physician burnout. The AMA then worked with Epic to put out notifications to all of their other clients in Ohio to clarify the regulatory change.
“It pays to keep asking questions, even if you get an answer that you don’t want a few times because things do change,” said Dr. Hopkins, a senior physician adviser for practice transformation at the AMA. “It is one of our goals at the AMA to encourage physicians and other health care workers to ask questions and to do it in a way that is not disrespectful or confrontational, but is genuinely based in a desire to know why we have to do something or why we have to do it in a certain way.”
An AMA playbook drawing from the AMA “Debunking Regulatory Myths” series can help physicians and others in their organizations become more inquisitive about why they are being asked to perform a certain task.
“Reducing Regulatory Burden Playbook: Avoid Overinterpreting the Rules” provides pointed questions that physicians can ask administrators and other decision-makers when they are told, among other things, that something is a regulatory requirement or that they need to get into compliance with something as soon as possible.
One study published in The Joint Commission Journal on Quality and Safety found that health care executives and managers had full control to change 78% of the obstructive and wasteful rules that physicians and patients identified. Dr. Hopkins said that often stems from those in charge of compliance overinterpreting rules and creating practice policies that have an unintended negative impact.
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™.
Here’s what to ask
Physicians need to feel empowered to question practices that may have been well-intended, but don’t seem to have value for their patients, said Christine Sinsky, MD, the AMA’s vice president of professional satisfaction. They need to be able to say, “I don’t think that is really achieving its goal, or “I think that’s actually making it harder for us to provide safe care.”
“It’s important that the voice of the practicing physician be solicited and be heard because physicians closest to the patient know what is helping and what is hindering them in the care of the patient,” Dr. Sinsky said. “When administrators and leaders seek out and respond to that perspective with respect and with the understanding that physicians and leaders have a shared mission of better patient care, the outcomes are better for all.”
Here are some highlights from the playbook’s guidance how to respond to frequently heard comments from health care organization administrators.
“This is a regulatory requirement”
Respond by asking:
- What regulation requires this? Could you please show me the regulation?
- Is this a federal or state agency requirement, or an organizational policy?
- Is there an organizational policy that includes our organization’s interpretation of the law or regulation and provides guidance on how to comply?
- What is our organization’s plan to ensure all stakeholders know what this law or regulation means?
- Is this being requested to achieve a specific goal? What is that goal?
- What are similar organizations doing with this requirement?
“Everyone is required to this”
Respond by asking:
- Are all physicians being asked to do this?
- What other roles or job types are required to do this?
- What is the minimum threshold for compliance?
“Why are you not following the new rules?”
Respond by asking:
- Could you show me the reason for the change?
- Is it required or optional?
- If it’s required, who is requiring it?
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“You need to get in compliance ASAP”
Respond by asking:
- Is there an organizational policy about this?
- Could you help me understand the purpose and process?
- Is any training available?
- When is the deadline for compliance?
- What are the consequences of noncompliance (individual and organizational)?
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.
