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Shop Textbooks. Read an excerpt of this book! Add to Wishlist. USD Sign in to Purchase Instantly. Temporarily Out of Stock Online Please check back later for updated availability. About the Author Susan Frampton, Ph. He became President and CEO in During his tenure he has positioned Griffin Hospital as an award-winning, innovative organization, recognized as an industry leader in providing personalized, humanistic, consumer-driven health care in a healing environment.
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Putting Patients First
Show More. Subscribe to Annals of Internal Medicine. Advanced Search. Position Papers 2 May Erickson, MPH. This article was published at Annals.
Individuals who served on the Medical Practice and Quality Committee at the time of the project's approval were Robert M. 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 , 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 growing number of administrative tasks imposed on physicians, their practices, and their patients adds unnecessary costs to the U. Excessive administrative tasks also divert time and focus from more clinically important activities of physicians and their staffs, such as providing actual care to patients and improving quality, and may prevent patients from receiving timely and appropriate care or treatment. In addition, administrative tasks are keeping physicians from entering or remaining in primary care and may cause them to decline participation in certain insurance plans because of the excessive requirements.
The increase in these tasks also has been linked to greater stress and burnout among physicians. Moreover, defining administrative tasks in health care also colloquially called hassles or burdens is nearly as challenging as the tasks themselves.
Tasks that become burdensome may differ from payer to payer; appear one month without notice, then reappear modified or changed the next; and often result from not using documentation that already exists in the medical record. Equally if not more challenging is to identify the best means to address these tasks to mitigate or eliminate their adverse effects on physicians, their patients, and the system as a whole. However, taking an analytic approach to defining and mitigating administrative tasks is critical to addressing them in a more comprehensive, cross-cutting, and holistic manner, rather than fixing one problematic task only to have another arise in its place.
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The ACP developed a framework Figure 1 and taxonomy Figure 2 for evaluating the sources, intent, effect, and consequences of existing and new administrative tasks. It proposes recommendations to reduce excessive administrative tasks in health care. Figure 1. Framework for analyzing administrative tasks. Figure 2. Each circle indicates a characteristic of an administrative task.
The committee is charged with addressing national, state, or local policies on improving access, payment, coverage, coding, documentation, and medical review, as well as developing programs to support the quality, safety, and affordability of patient care. To better understand the effects of administrative tasks on practicing clinicians, their patients, and the physician—patient relationship, the committee analyzed the literature by conducting a scoping review and environmental scan.
The initial literature review was done in early and later updated with 2 additional searches to identify any relevant new articles. Only articles published in or later were considered. In total, more than 60 articles were reviewed, with about half meeting the following screening criteria:. Studies focusing on the burden of disease or illness, cost or financial burden of disease or illness, or cost of drug or health insurance administration were excluded.
Priority was given to articles or reports presenting evidence from data-driven research rather than opinion.
A limited number of editorial reviews, letters, perspective pieces, and clinical guidelines were included. Although this paper briefly discusses issues related to physician workforce and burnout, the literature review focused primarily on assessing the effects on physician time, practice and system cost, and patient care due to the increase in administrative tasks, and then to identify recommendations to modify, mitigate, reduce, or eliminate these tasks as appropriate.
The ACP's Medical Informatics Committee reviewed draft recommendations referencing the use of health information technology. After considering the sources, intents, and effects of administrative tasks in health care—and the literature addressing these issues—the committee developed the following 7 public policy statements and recommendations as strategies to put patients first by reducing excessive administrative tasks in health care.
The ACP calls on stakeholders external to the physician practice or health care clinician environment who develop or implement administrative tasks such as payers, governmental and other oversight organizations, vendors and suppliers, and others to provide financial, time, and quality-of-care impact statements for public review and comment.
This activity should occur for existing and new administrative tasks. Tasks that are determined to have a negative effect on quality and patient care, unnecessarily question physician and other clinician judgment, or increase costs should be challenged, revised, or removed entirely.
See Appendix Figures 1 and 2 for examples.
Appendix Figure 1. Appendix Figure 2. Stakeholders, including public and private payers, must collaborate with professional societies, frontline clinicians, patients, and electronic health record 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. To facilitate the elimination, reduction, alignment, and streamlining of administrative tasks, all key stakeholders should collaborate in making better use of existing health information technologies, as well as developing more innovative approaches.
As the U.
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The ACP calls for rigorous research on the effect of administrative tasks on our health care system in terms of quality, time, and cost; physicians, other clinicians, their staff, and health care provider organizations; patient and family experience; and, most important, patient outcomes. The ACP calls for research on best practices to help physicians and other clinicians reduce administrative burden within their practices and organizations. All key stakeholders, including clinician societies, payers, oversight entities, vendors and suppliers, and others, should actively be involved in the dissemination of these evidence-based best practices.
The ACP presents a framework for analyzing administrative tasks through the lenses of sources, intents, effects, and solutions. This framework enables a better understanding of each administrative task that a clinician and his or her staff may be required to complete. This framework is the backbone of ACP policy recommendations for stakeholders outside the physician practice or health care provider environment such as payers, governmental and other oversight organizations, and vendors and suppliers regarding the assessment of each administrative requirement, regulation, or program to determine whether it should be challenged, revised, or eliminated entirely.
These recommendations also outline steps that key stakeholders can and should undertake to align and streamline, transparently and cohesively, administrative tasks that remain in place.
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These guidelines are particularly important as the health care system evolves from one based on the volume to one based on the value of services provided. The ACP also calls for meaningful collaboration to improve the development, testing, and implementation of measures and to ensure that health information technology is used as innovatively as possible to streamline processes and reduce burden.
In addition, although some consistency was found in the literature analysis on the effects of administrative tasks, much more research is needed in that area, as well as on the subject of best practices to mitigate or reduce the burden of these tasks. Once defined, best practices must be disseminated widely. Excessive administrative tasks have serious adverse consequences for physicians and their patients. Stakeholders must work together to address the administrative burdens that prevent physicians from putting their patients first.
The ACP has long identified reducing administrative tasks as an important objective, maintaining significant policy and participating in many efforts with this goal in mind.
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