The American Academy of Family Physicians (AAFP) is calling for the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) to take a number of steps to reduce clinician burden from health information technology. One of its recommendation called for ONC and CMS to minimize health IT utilization measures.
The physician organization sent a letter to Seema Verma, CMS Administrator, and Don Rucker, M.D., National Coordinator for ONC, in response to CMS’s request for proposals to simplify regulation, as part of its Patients over Paperwork initiative. The letter spelled out specific administrative burdens that draw physicians away from patient care, including EHR documentation, prior authorization and the proliferation of quality measures.
In its letter, AAFP states that the current regulatory framework with which primary care physicians must comply is “daunting and often demoralizing.” “Standardization is not required among public or private payers, and many family physicians participate with 10 or more payers. Physicians are forced to navigate rules and forms for each payer. As a result, physicians spend needless hours reviewing documents and literally checking boxes to meet the requirements of each health insurance plan. This is time that physicians could better spend caring for patients,” AAFP wrote.
A study involving 142 family physicians conducted over a three-year period from 2013 to 2016 concluded that primary care physicians spend nearly six hours daily, or nearly one-half of their workday, interacting with electronic health records (EHRs) during and after clinical hours, AAFP officials contend.
“It is unfortunate and avoidable that the regulatory framework for physician practices has reduced face-to-face time with patients and increased operating costs at a time when physician payment is stagnant," the AAFP wrote. “Crushing administrative and regulatory burden is one of the top reasons independent practices close and a leading cause of physician burnout.”
And the AAFP offered a number of consensus principles on administrative simplification, and encouraged CMS and ONC to adopt policies and practices consistent with these principles to alleviate unneeded regulatory burdens and to improve patient care.
Now that the Merit-based Incentive Payment System (MIPS), under MACRA, utilizes measures of quality, cost and practice improvement, the AAFP is calling for all health It utilization measures to be eliminated.
Recognizing that some of these uses are mandated in statute, AAFP is calling for CMS and ONC to work with Congress to remedy that situation. AAFP also is calling on CMS and ONC to eliminate some evaluation and management measures for primary care physicians and to focus interoperability policy on information blocking and how data is to be exchanged.
“The AAFP calls on CMS and ONC to reform regulatory requirements to focus instead on how and when data is exchanged rather than focusing on the data in the exchange. The AAFP calls on CMS and ONC to fully use its Information Blocking authority granted in 21st Century Cures to penalize those healthcare organizations not appropriately sharing information. We believe the priority relative to health IT is to improve usability and then focus on interoperability,” AAFP stated in the letter.
The organization also wants more standard clinical data models and consistent quality measure reporting. With regard to prior authorizations, AAFP said any demands for prior authorization must be justified in terms of cost and burden, and then laid out several other steps toward a solution.
"Rules and criteria for prior authorization determination must be transparent and available to the prescribing physician at the point of care," the letter stated. "If a service or medication is denied, the reviewing entity should provide the physician with the reasons for denial."
Prior authorization also should be eliminated for physicians who participate in shared savings programs and those who demonstrate proven ability to provide low-cost, effective care.
Importantly, insurers should be required to pay physicians for the time they spend with prior authorizations that exceed a specified number or that are not resolved within a designated time period, AAFP stated in the letter.