A Balancing Act: Oncologist Explains the Impact of Physician Administrative Burdens

One of the first sessions to kick-off the annual meeting of the American Society of Clinical Oncology (ASCO), held at the McCormick Convention Center, Chicago, May 29 to June 2, 2015, was a talk on the growing administrative burden on oncology practices. During the session, Robin Zon, MD, FACP, FASCO, a practicing medical oncologist from Michiana Hematology Oncology, PC, discussed the time and resources utilized by the physician and the practice staff as they struggle to balance administrative burdens with clinical care.

Physicians often complain about the increasing record of metrics and measures that they have to maintain, especially with the transition to value-based payment models, and how that siphons vital resources within a practice that is already stretched on reserves.

In her talk, “Growing Concern of Administrative Burdens in Practice,” Dr Zon defined administrative burdens as “costs imposed on businesses, when complying with information obligations stemming from Government regulation”—a definition coined by the Better Regulation Unit.¹

However, there is no oncology-specific database that provides this information, she said, although many oncologists are distressed by this burden. A survey conducted by the State Affiliate Council—an advisory group to ASCO’s board of directors—through its Dashboard initiative, which was launched in September 2014, asked oncologists about the impact of prior-authorization requirements by payers on their practice. A majority of provider responses were that it increased staff time spent per week, increased staff dissatisfaction, and did not seem to improve clinical outcomes.

“Will prior authorization have any effect on clinical decision-making?” Dr Zon asked.

Prior-authorization is just one of the time-consuming burdens that practices face. When surveyed on the number of clinical pathways that practices have to follow—either payer-implemented or developed in-house, several responders said they had between 5-8 different clinical pathways in their practice, and a majority were payer-initiated.

“Pathways are here to stay," said Dr Zon, but they need to be improved and they need to change over time.

The transition from volume to value is another important change in the healthcare industry that is increasing the documentation needs for physician practices. Thomas Gallo, MS, said at an Association of Community Cancer Centers meeting that in an attempt to collect data, which is the backbone of value-based programs, smaller practices are merging with bigger ones. Citing a recent article in the New England Journal of Medicine² by the HHS Secretary Sylvia Burwell, Dr Zon said that the government is focused on transforming our healthcare system through value-based payment goals. But at the end of the day, these goals will all increase the physician and practice requirements for documentation.

“A 2008 survey by 2 internists found that an average doctor spends 8.7 hours/week and 1.7 hours/day on administration, which averages to 16.6% of their working hours,” said Dr Zon. So about 168.4 million hours were spent in on administrative duties, resulting in lower career satisfaction. The authors predict that in 2014 the total cost of physician time spent on administrative duties will amount to $102 billion.³

“This means a decrease in the number of hours that we spend in doing what we are supposed to do, which is patient care,” said Dr Zon. “I think this would result in disastrous outcomes.”

“To deliver the highest quality and highest value care to patients, we need a collaboration between payers, providers, industry, patients, and employers.”

References

1. Better regulation website. Administrative burdens. www.bru.gov.mt/administrative-burdens. Accessed May 29, 2015.

2. Burwell, SM. Setting value-based payment goals—HHS efforts to improve U.S. health care. N Engl J Med. 2015; 372(10):897-899.

3. Administrative work consumes one-sixth of U.S. physicians' time and erodes their morale, researchers say [press release]. http://www.pnhp.org/news/2014/october/administrative-work-consumes-one-sixth-of-us-physicians%E2%80%99-time-and-erodes-their-mor. Chicago, IL: Physicians for a National Health Program; October 23, 2014.