ACP urges collaborative action to put patients before paperwork

Internist Adi Puplampu, MD, considers himself a “wounded soldier,” having left the full-time practice of medicine after the strains of day-do-day patient care took a toll on his physical and mental health.

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“I feel like physicians are a dying breed,” Puplampu told colleagues at this year’s American College of Physicians (ACP) conference in San Diego, California. “What is at stake is the health of a nation … and someday, we will all be patients.”

The Wisconsin-based physician, who now serves as a payer consultant, detailed his personal story after a session on alleviating the stress on today’s internists due to mounting administrative tasks and paperwork mandated from insurance companies, government agencies, and others.

“Time is the true asset here [for physicians], but unfortunately money controls that,” Puplampu said. “We need a ground strategy.”

The ACP hopes it has that ground strategy through its new “Patients Before Paperwork Initiative,” identifying the major issues facing internal medicine physicians today and perhaps more importantly, putting in motion an action plan to reduce these excessive administrative burdens.

Developed from a recently published position paper, the association was able to identify the main three administrative stressors for today’s internists: electronic health record (EHR) usability, quality measure reporting and dealing with payers.

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To assist physicians, the ACP developed policy recommendations to work with healthcare stakeholders-from insurance companies to health IT firms-to alleviate the burdens facing physicians like Puplampu.

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The policy recommendations include:

• Stakeholders developing or implementing administrative tasks should provide financial, time and quality of care impact statements for public review and comment;

• With more focus on value-based care, stakeholders should review and consider streamlining or eliminating duplicative administrative tasks; and

• Aiming 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.

Nitin S. Damle, MD, MACP

“We need to work together with payers and other stakeholders to really make a difference,” said ACP President Nitin S. Damle, MD, MACP, who is also a practicing physician in Wakefield, Rhode Island.

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Shari Erickson, MPH, vice president of governmental and medical practice for the ACP, said the organization has already sent advocacy letters to several stakeholders urging action on their policy recommendations, including America’s Health Insurance Plans, the Centers for Medicare & Medicaid Services and the Health Information Management Systems Society’s EHR Association, comprised of various system vendors.

“We’ve already heard back [from some] interested in engaging in discussions with us,” said Erickson, adding that she was “encouraged” from the early feedback.

Internists attending a session were thankful for the initiative, but others, like Puplampu, felt time was not on the ACP’s side.

“This is a case of too little, too late,” said Henry Haire, MD, FACP, medical director for Florida Atlantic University’s Resident Internal Medicine Clinic, who, like Puplampu, left his day-to-day internist practice after 22 years to go to academia.

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Now, as a teacher of future physicians, Haire said he sees residents already turning away from a career in practicing medicine for other endeavors due to the various stressors that await them in the profession.

“We’ve killed the future of primary care practice,” he said. “But I believe there is hope.”

Next: Reducing administrative tasks

ACP's 7 policy recommendations to reduce administration tasks

1. Calling on external stakeholders who develop or implement administrative tasks to provide financial, time and quality of care impact statements for public review and comment.  Tasks that have wholly negative impacts should be eliminated.
2. Regular review, revision, alignment or streamlining of any administrative tasks that cannot be eliminated, in a transparent manner, with the goal of minimizing burden.

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3. Collaboration by stakeholders with specialty societies, frontline clinicians, patients, and EHR vendors to aim for performance measures that minimize unnecessary clinician burden, maximize patient- and family-centeredness, and integrate the measurement of and reporting on performance with quality improvement and care delivery.
4. Collaboration by stakeholders to make better use of existing health information technology and to develop more innovative approaches.
5. Review and consideration by stakeholders, with a focus on value, of how to streamline or eliminate duplicative tasks.  More specifically, they should consider decreasing oversight or requirements for physicians who have a demonstrated high-performance or are taking on greater financial risk in innovative care-delivery approaches.
6. Calling for research into the impact of administrative tasks on our health care system in terms of quality, time and cost.
7. Seeking research into how to help physicians and other clinicians reduce administrative burdens within their practices and organizations.

Source: American College of Physicians