Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians

Abstract

This American College of Physicians (ACP) position paper, initiated and written by ACP's Medical Practice and Quality Committee and approved by the Board of Regents on 21 January 2017, reports policy recommendations to address the issue of administrative tasks to mitigate or eliminate their adverse effects on physicians, their patients, and the health care system as a whole. The paper outlines a cohesive framework for analyzing administrative tasks through several lenses to better understand any given task that a clinician and his or her staff may be required to perform. In addition, a scoping literature review and environmental scan were done to assess the effects on physician time, practice and system cost, and patient care due to the increase in administrative tasks. The findings from the scoping review, in addition to the framework, provide the backbone of detailed policy recommendations from the ACP to external stakeholders (such as payers, governmental oversight organizations, and vendors) regarding how any given administrative requirement, regulation, or program should be assessed, then potentially revised or removed entirely.

Cross‐sectional survey of workplace stressors associated with physician burnout measured by the Mini‐Z and the Maslach Burnout Inventory

“…Once added, it could be regularly reviewed, revised, reduced, eliminated, simplified, streamlined, or automated. (Association, ; Erickson, Rockwern, Koltov, & McLean, ; Woolhandler & Himmelstein, ) Documentation could be further assisted by scribes or shared with clinical teammates (team‐based documentation and in‐baskets, nonphysician order entry). (Sinsky et al, ) Team‐based patient care is conducted with allied health professionals via “teamlets” or through the expanded roles of medical assistants who participate throughout the patient encounter rooming, scribing, preparing discharge instructions, and coaching patients (Chapman & Blash, ; LaVela & Hill, ; Oostra, ; Swensen et al, ; Willard‐Grace et al, ).…”

Can Rationing through Inconvenience Be Ethical?

“…In an influential essay, Gerald Grumet characterized “rationing through inconvenience” as a potent but secretive strategy for “slowing and controlling the use of services and payment for services by impeding, inconveniencing, and confusing providers and consumers alike.” Donald Light similarly decried “practices [that] include rejecting claims in whole or in part for procedural or technical reasons, making the claims process and its rules extremely complex, and [ultimately] inducing claimants to give up.” For clinicians, the phrase “rationing through inconvenience” usually evokes wasted time, unnecessary red tape, byzantine bureaucratic systems, escalating administrative expenditures, and even “ambiguity, deception, or harassment.” For patients, inconveniences like paperwork and travel can stand as a barrier to using insurance or accessing needed health care. Recent efforts, for example, by the American College of Physicians, have sought to mitigate or eliminate administrative tasks and their adverse effects …”

“…Therefore, it may never come to pass, and if it did, it may prove politically unstable. Doctors, in particular, are already struggling to cut administrative chores and may fiercely object to compounding inconveniences to them …”

“…Recent efforts, for example, by the American College of Physicians, have sought to mitigate or eliminate administrative tasks and their adverse effects. 4 However, inconvenience of service use is also a commonplace rationing mechanism for encouraging socially preferred choices. Consider the following examples:…”

Tincture of time

“…The American College of Physicians (ACP) 36 has linked increasing administrative tasks to greater stress and burnout in physicians and developed the Patients Before Paperwork initiative in 2015. 37,38 The same year, the NEJM Group 8 launched NEJM Catalyst, 9,10 a think-tank engaged in the burnout conversation which recently released a publication entitled Physician Burnout: The Root of the Problem and the Path to Solutions 7 . Most medical schools and residency programs have launched wellness programs.…”