We are excited to present this article, reprinted with permission from Ryan Hess, Vice President of Product Innovation at Surescripts.
It’s no secret that today’s physicians are expected to do more with less—less than complete patient information, less time to spend with each patient, fewer resources in general—all while delivering high-quality, cost-effective care to an increasingly value-focused and highly regulated consumer marketplace. The stakes are high, and many of these factors can lead to physician burnout.
A recent national study reported that nearly two-thirds of U.S. physicians are burned out, depressed, or both. And one in three physicians expressed that their depression impacts how they relate to their patients. Of those surveyed, the physicians who reported being the most burned out (47 percent) are family doctors. They are also the least happy at work (22 percent). More than half (56 percent) of the surveyed physicians said too many bureaucratic tasks are contributing to their feeling burned out.
Prior authorization is still a major pain point
Let’s take a look at prior authorization. According to the 2017 American Medical Association Prior Authorization Physician Survey of 1,000 practicing physicians, 84 percent say the prior authorization process is a significant burden for their practice. Together with their staff, the average physician spends 14.6 hours a week handling prior authorizations, and 34 percent of physicians have staff dedicated exclusively to the process. Sixty-four percent of physicians report waiting at least one business day for payer decisions, and 30 percent report waiting three or more business days.
From a care quality standpoint, 92 percent of physicians report that prior authorizations have a negative impact on patient clinical outcomes, and 78 percent say that it causes some of their patients to abandon treatment.
These insights from physicians point out that despite their best efforts, ineffective, tedious, and repetitive administrative tasks not only waste time and resources while causing burnout—they can also ultimately undermine care quality and patient safety.
Administrative swirl due to pharmacy sticker shock burdens physicians and risks patient safety
Along with prior authorization, a chronic issue that contributes to physician burnout is the administrative swirl that begins with prescription drug cost “sticker shock” at the pharmacy.
Most of the time, neither physicians nor their patients know what their out-of-pocket drug cost will be until they arrive to pick up their medications. This is because physicians haven’t historically had access within their EHR to patient-specific cost and coverage information—plus therapeutic alternatives like generics—at the point of prescribing.
But according to the Surescripts/GLG Script Writing Technology Evaluation Survey (2016), most physicians, or 86 percent, believe that it’s either extremely or very important to have this information when prescribing. And 97 percent believe that it’s also important to have cost-effective medication alternatives at the point of prescribing.
This forces everyone out of their regular workflows and into a frustrating and time-consuming game of phone tag. Multiple phone calls take place in order to understand what’s covered, what requires prior authorization and what the out-of-pocket cost will be—all in the name of enabling the patient to start and stick with their medication regimen. Complicating things further is the fact that the patient may abandon treatment altogether, which can make existing health problems worse while putting them at risk for new ones.
Saving physicians from circling the administrative drain
The good news is that physicians have access today to EHR-integrated prescription drug price transparency and prior authorization tools, which work together seamlessly to create an optimal experience for patients, pharmacists and physicians while helping to prevent or relieve physician burnout.
With actionable patient intelligence delivered to the point of care, physicians see how much a medication will cost their patient based on their specific health plan coverage. Together, physicians and patients can use this information to choose the drug option that is both medically appropriate and most affordable. And if a prior authorization is required, it can be completed electronically, and in most cases while the patient is still in the doctor’s office.
Prescribers who use the integrated Surescripts price transparency and prior authorization tools within Quanum® EHR report that it truly helps them save time and money for their practices and patients, and it’s helping improve medication adherence. They appreciate having visibility to equally effective alternative therapies which empowers them to collaboratively choose medications that they know their patients can afford. What’s more, by removing the need for phone calls and faxes to determine coverage, the price transparency capability frees them to focus on the patient who is right in front of them.
Specific feedback shared by prescribers includes: “This helps me choose a medication that will be available to my patient at a good price,” “This reduces the number of phone calls for myself and staff if a particular medication isn’t covered,” “Very relevant in today’s practice,” and “It’s always good to know what the alternatives are.”
Using price transparency and electronic prior authorization tools together means that physicians are alerted to the patient’s out-of-pocket cost and coverage requirements like prior authorization and can have a conversation with their patient about their options to stay with the high-cost therapy, choose a lower-cost alternative or one that doesn’t require a prior authorization.
As a result, the patient leaves for the pharmacy confident in both the medication choice and the medication cost, knowing that it will be covered by their insurance. And the physician can be confident that their patient will receive and begin their drug regimen without confusion over cost, delays due to prior authorization or having to repeat the prescribing process all over again.
Enabling physicians to do things right the first time—while staying within their EHR workflow—can go a long way to preventing and relieving physician burnout. By removing the friction from the necessary administrative processes of prescribing medication, physicians are free to redirect their time and effort away from administrative tasks and back to meaningful patient interactions and safe and high-quality patient care. Learn more about Quanum EHR.
Ryan manages the Medication Information Services division of Surescripts, which encompasses Benefit Optimization, Prior Authorization, Medication History, Specialty Medications and Insights & Alerts solutions. He joined Surescripts in 2013 after nine years working with a variety of healthcare clients at the management consulting firm Bain & Company.
Disclaimer: The views expressed in this blog post do not necessarily reflect the views of Quest Diagnostics® or any of its employees.