Ask physicians about the time-gobbling activities they must do during their days to meet compliance standards, and it likely will not take them long to name a few.
Chances are, though, that the burdensome tasks a physician identified are not really necessary to meet compliance rules. In fact, health care executives and managers had full control to change 78% of rules that physicians and patients identified as obstructive and wasteful, according to a study published in The Joint Commission Journal on Quality and Safety.
“When you look at the organizations and the regulatory agencies that oversee health care, it’s pretty diverse,” said Kevin Hopkins, MD, who is the physician director of health system engagement for the AMA during a recent AMA webinar. “The stakeholders include federal regulatory agencies, state boards, accreditation agencies … but it also includes things like payers, EHR vendors and even a physician’s own health care system. Additionally, there are associations, societies and advocacy groups that make statements and nonbinding recommendations that are sometimes misinterpreted or overinterpreted as ‘regulatory requirements.’ As a result, physicians today feel the tremendous oversight and regulatory burden from both internal and external sources.”
Physicians shouldn’t be afraid to question compliance officers about things they find burdensome. For example, can nonphysician care team members respond to patient messages? Does the Centers for Medicare & Medicaid Services really prohibit using note templates? Is two-factor authentication required for all prescriptions?
Physicians can then begin to eliminate the unnecessary burdens for physicians by working with clinic or hospital compliance professionals to make changes, explained Dr. Hopkins and his co-host of the webinar, Robyn Hoffmann. She is senior manager of compliance for the health care practice group at the consulting firm of Berry, Dunn, McNeil & Parker LLC.
“When you think about regulatory compliance and physician leaders separately, it’s easy to see how we might have very different goals,” said Dr. Hopkins, a family physician at Cleveland Clinic. “But if we step back and take a look at the larger picture from a holistic point of view, compliance and clinical teams have much more in common than not.”
How to work together
Physician leaders and compliance leaders share many of the same goals. To name a few: safe, high-quality patient care; maintaining accreditation; minimizing risks; safeguarding patient privacy; and serving as role models for ethical behavior.
“When we think about all of these things and if we can do them successfully and work together, physician leaders and compliance officers can help to achieve the Quadruple Aim,” Dr. Hopkins said. “We can build a culture integrity and share accountability in which patient safety and compliance and physician well-being can benefit.”
Some ways physician leaders can work with compliance leaders in their organizations:
- Identify shared values, explore opportunities for collaboration and develop mechanisms for communication.
- Assume positive intent by each other.
- Not take things personally.
- Be approachable and responsible.
- Be a go-to resource.
- Ask more questions and make fewer statements.
- Make written messages clear and succinct.
- Partner with quality improvement and design rapid cycle Plan/Do/Study/Act projects.
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What’s at stake
Dr. Hopkins said organizations need to understand and recognize how unnecessary regulations and potential overinterpretation of the regulations can impair efficiency and increase burnout for physicians.
“Sometimes we put handcuffs on ourselves,” he said. “Regulatory burden and regulatory requirements necessarily slow us down so that we can provide safe patient care and prioritize safety. And yet sometimes they slow us down to the point that they impede our optimal efficiency and actually can create unintended negative consequences, even patient dangers.”
Overinterpreted regulatory requirements contribute to physician burnout, a phenomenon that one study showed cost the health system $4.6 billion annually, or about $7,600 per physician each year. And that study only accounted for physician turnover and lost productivity. It didn’t account for things such as higher rates of medical errors and decreased patient satisfaction, which are known to contribute to burnout and higher costs.
These are some of the areas that are negatively affected when health care organizations overinterpret regulatory requirements:
- Workload: administrative burden and excessive documentation.
- Cognitive: Cognitive overload for clinicians, dissatisfaction among physicians and other team members, clinician burnout.
- Organizational: Eroding trust between physicians and health system leaders, care team dysfunction, building an adversarial relationship between clinicians and policy makers.
- Patient care: Impeding the patient-physician relationship, reducing patient care capacity and access to care, raising health care costs, and harming patients.
Resources to help your organization
The AMA “Debunking Regulatory Myths” series answers questions physicians have about whether a certain practice is really necessary to meet compliance requirements. The easy-to-understand explanations provide resources to reduce guesswork and administrative burdens.
An AMA STEPS Forward® resource called “Reducing Regulatory Burden Playbook: Avoid Overinterpreting the Rules” provides pointed questions that physicians can ask administrators and other decision-makers when they are told, among other things, that something is a regulatory requirement or that they need to get into compliance with something as soon as possible.
Dr. Hopkins, Hoffman and Lindsey Carlasare, a senior manager for research and policy at the AMA, recently published an article in Compliance Today, a journal for Health Care Compliance Association members, that examines physician and compliance leaders’ shared accountability to reduce regulatory burden and promote well-being.
