Three areas where progress is being made on administrative simplification

Administrative tasks take up too much of family physicians’ time, but efforts are underway to streamline burdensome processes.

1. Streamlining prior authorizations: The American Academy of Family Physician’s (AAFP) position is that prior authorizations should be eliminated for durable medical equipment, medical supplies, and generic drugs. Before being used for other items, prior authorizations should be justified in terms of their financial recovery, and the rules should be transparent and easy to follow. Congress has introduced two bills, endorsed by the AAFP, that would help on this front. The “Improving Seniors' Timely Access to Care Act” would reform prior authorization within Medicare Advantage plans, and the “Safe Step Act” would streamline step-therapy requirements for prescription drugs within employer-based health plans. Both bills have bipartisan support. Late last year, the Centers for Medicare & Medicaid Services also proposed a new rule to automate prior authorization requirements in state Medicaid plans and private plans sold on the Affordable Care Act exchange. Implementation of the rule has been delayed as the Biden Administration reviews it, but the new administration is expected to adopt it eventually.

2. Aligning quality measures: With public and private payers rolling out their own quality and performance measures, there has been little coordination to make sure they are in harmony with each other, or even that they’re relevant to family medicine. The AAFP and other groups have been advocating for a single, more meaningful set of measures that reflect the true value of family medicine. That effort includes the 2019 formation of the Patient-Centered Primary Care Measure, which focuses on access, comprehensiveness, coordination, continuity, care management, and patient engagement.

3. Reducing medical record documentation: EHRs have increased the amount of time most physicians spend on documentation. But the evaluation and management (E/M) coding and documentation changes that took effect this year chipped away at that burden. The new guidelines eliminated the need to check boxes for history or exam to get credit for a certain level of service. They also allow physicians to code office/outpatient E/M services based on total time whenever they wish to do so, eliminating the previous need to determine whether counseling or coordination of care dominated the encounter. The AAFP has developed coding and documentation resources to help physicians take advantage of the changes.

Read the full FPM article: “The Quest for Administrative Simplification: What’s Being Done.”