Top 3 challenges of 2022

Each year, the Medical Economics® team surveys their audience to find out what big challenges practitioners faced. By far, the top answer was “administrative burdens,” including staffing, prior authorizations and electronic health records (EHRs). Let's take a closer look at what these burdens entail to help physicians get ready for whatever challenges 2022 will bring.

This article was compiled using Medical Economics®' annual survey.

1. Hiring and retaining staff

Hiring and retaining staff can be difficult, especially during the COVID-19 pandemic. A lack of interest for applicants may include a lack of advancement opportunities, generational differences, greater salaries in other industries, and an interest in virtual work. Plus, the “Great Resignation” of 2021 — the trend of people quitting their jobs — has hit most industries as many reexamine their work/life balance.

What you can do to improve hiring and retention

Increase compensation and incentives.

Money talks, but so do benefits and perks. Offer sweeteners that workers will not find anywhere else.

Add flexibility.

The days of the 8 a.m. to 6 p.m. workplace are quickly fading. Although it is unreasonable for a practice to allow employees to work whenever they want, be open to having them work at different times on certain days so they can attend to family and other life issues.

Go digital.

When looking for new employees, utilize job sites like Monster.com on both a local and regional level. Use your internal social media channels for networking and finding worker talent.

Have open dialogue.

For current staff, ask employees what they want and what issues they are having. Solve problems before they get too big and fix concerns that are reasonable. Employees will appreciate that you listened.

Go beyond health care.

Practices often prefer those with experience in health care, but many qualified people have never worked in a practice. Be open to bringing in bright people from outside the health care arena. 

“This is a big problem for everyone,” says Halee Fischer-Wright, M.D., M.M.M., FAAP, FACMPE, president and CEO of Medical Group Management Association (MGMA), a medical practice advocacy organization. “Health care is as much impacted as every industry is across the globe at this time.”

A drop in patient volume at the onset of the pandemic led to some medical practice staff being furloughed, and many decided not to come back when things picked up. “One of the more interesting statistics is that one-third of nonclinical staff not coming back are not vaccinated,” Fischer-Wright says. “The MGMA has heard that 88% of medical practices (have) had difficulties recruiting front-of-office staff.”

The most obvious way to entice people to take jobs is by offering higher salaries and better benefits, but a practice can utilize extras that can raise interest in working there. Examples include allowing flexible hours, treating employees to lunch twice a week or paying for transportation costs. These perks could make the practice appealing to someone looking for work.

“We recommend being aggressive in recruiting strategies and not waiting until you need staff, so you can start to develop the relationships that help to bring new people in that can contribute immediately when needed,” Fischer-Wright says. “Practices also need to optimize their practice to make employees happy.”

When it comes to retaining staff, Fischer-Wright believes the key is to alleviate boredom, which often comes down to repetitive tasking. “We recommend that physicians take a look at practice operations and weed out what is necessary versus what is habit,” she says.

A good solution is cross-training staff, so different people can take turns doing tasks with less chance of burnout. It is also a good idea to increase communication among the staff, so you can learn of concerns early.

“What we see in workers today is that they want this delightful combination that’s almost impossible to achieve — both flexibility and certainty,” Fischer-Wright says. “What we find in medical practices is often they work by need-to-know, so we’re encouraging a much more holistic communication strategy even within the smaller practices so people understand what’s going on.”

2. Electronic Health Records

Since their introduction, EHRs have been a perennial issue for physicians across all specialties. From user experience to interoperability, nearly every facet of the computer-based systems has drawn the ire of those using them.

Tips to improve EHRs

David Lareau, CEO of Medicomp Systems, says medical practices can combat the burnout associated with EHR use by focusing on these four core areas for improving their systems.

Improving patient care.

Incorporate technological tools that work behind the scenes to capture and interpret billing and coding detail. Streamlining work flow in this area can help physicians quickly find medical information they need to achieve better health outcomes for patients.

Increasing physician productivity.

Workflows supporting the automatic identification and interpretation of medical information from previous sessions, inpatient records, laboratory reports and other sources allow physicians to focus on the patient instead of their computers. EHRs should not disrupt the way physicians think and work.

Ensure accurate reimbursements.

Rather than using inefficient, error-prone manual methods, practices should incorporate technologies that prompt the physician at the point of care when patients have potential hierarchical condition category conditions, allowing the doctor to immediately address treatment, documentation or coding gaps while the patient is in the room rather than during a follow-up appointment.

Reducing operational expenses.

EHR systems can reduce operational expenses by enhancing clinician productivity and streamlining documentation, coding and billing processes. Documentation tools that support quick, efficient capture of visit information at the point of care can reduce or eliminate the need for transcription services.

A recent study found that the amount of time spent in the physician’s inbox and total time using EHRs were associated with higher physician turnover. However, it was found that less time spent on EHR-based tasks was correlated with a higher rate of physician turnover.

Despite this finding, physician burnout tied to EHR use is greater than initially anticipated. The American Medical Association found that EHRs contribute to between 11% and 60% of the burnout physicians experienced in 2021. With the implementation of new information-blocking rules — aimed to prevent EHR vendors from interfering with record access or exchange — from the Office of the National Coordinator for Health Information Technology on the horizon, 2022 has the potential to be another year of EHR frustration.

3. Prior authorizations

Doctors want to care for patients in the ways they were trained to, but often find themselves arguing with an insurance company about the best course of treatment. This is the main reason physicians consistently rank third-party interference as one of their biggest challenges.

How to streamline the prior authorization process

Assign a staff member to each payer. This person can become an expert on the payers for which they are responsible, learning their specific expectations and what to avoid. They can also build relationships with their counterparts at the payer, which may help expedite claims and appeals. This person should also create a basic guidebook for each payer that others can follow if needed.

Maximize the use of technology.

Most payers offer online forms for the prior authorization process and some EHRs integrate directly with payer formularies. The more a practice can use these online forms, the more quickly an authorization can be obtained. In many cases, any missing information will be flagged before submission.

Document all treatment decisions and back them up with evidence-based practices.

Payer justification for prior authorizations is that physicians are not always following the latest evidence-based practices, so ensure all treatment decisions are based on the latest guidelines. If a prescription is not following the formulary, make sure all information as to why it is not is included in the prior authorization form.

Prepopulate forms for each payer.

In some cases, you may be able to create a prepopulated form that has common information from the practice already filled in. This just leaves the specific patient information to be added. Although the time savings may be small for each form, it can add up when multiplied over the course of a year.

Create a spreadsheet outlining what treatments and medications for frequent diagnoses require a prior authorization by payer and what the permitted alternatives are.

Having a quick-reference guide can save physicians time by directing them toward treatments the insurance company will accept.

Inquire about gold card programs.

Some payers offer physicians with a good track record of following clinical best practices a gold card that allows them to skip the prior authorization process for some treatments. Find out whether you are eligible and what it takes to earn eligibility.

Fight to get rid of the prior authorization burden.

Most professional medical societies have come out against prior authorizations and are pushing for legislation to limit their use. Check with your organization to find out how you can help. Write to your state and federal representatives and explain how the process harms patient care and raises health care costs.

“The problem with a lot of insurance companies is they change what’s on their formularies, and one day the insulin NovoLog is covered and then next day it changes to Humalog, and now the patient has to switch and it’s very confusing. And if you want to keep them on the same one, you have to put in the prior authorization, and the insurance company wants them to try the other one first,” says Richard Bryce, D.O., a family medicine physician and chief medical officer for the Community Health and Social Services Center in Detroit.

This back-and-forth costs the practice time and money and puts the patient’s health at risk.

“Now you’ve wasted a week or two figuring this process out when a patient needed the medication to take care of their ailment,” Bryce says. “The process should be easier.”

Although prior authorizations aren’t going away, there are some strategies practices can use to streamline the process.

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