Disclosure of Financial Relationships

1. Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of PhysiciansMarch 30, 2017ACP Medical Practice & Quality CommitteeChair, 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

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

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

16. 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