Recent reports indicate that physicians are stressed and overburdened by several administrative challenges, leaving them with less time for patient care.

1. Top 5 Administrative Challenges
Facing Physicians
Recent reports indicate that physicians are stressed and
overburdened by several administrative challenges, leaving
them with less time for patient care.
Medical Transcription Services
United States

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Today, physicians are striving to deal with several challenges, while running their practice
and caring for their patients. Medical transcription outsourcing helps them manage the time
demands of electronic health record (EHR) data entry. However, reports from industry
resources such as Medical Economics indicate that physicians are stressed and
overburdened by administrative and other challenges. Administrative burden was identified
as a key contributor to physician dissatisfaction in when physician burnout was declared a
public health crisis in a 2017 Health Affairs blog. Here is an overview of the main
administrative challenges physicians are facing today:
• Paperwork involved in pre-authorizations: Payers require prior approval for
physician-ordered medical tests, clinical procedures, medications, and medical
devices. Benefit coverage is determined based on the medical necessity of the
services, tests or procedures for the patient. The aim is to optimize patient outcomes
by ensuring they receive the most appropriate treatment/medication, curbing waste,
and controlling healthcare costs. However, the paperwork involved in getting pre-
authorizations for medications and tests is burdensome. Physicians need to fill out
forms and submit forms to payers to get approval for everything from medications
and procedures to consultations.
Most insurers require a referral form be completed prior to sending a patient to a
specialist for evaluation. In the case of complex prior authorizations, comprehensive
and complex documentation may be needed of every interaction, including answers
to multiple questions regarding the patient’s condition. Referring providers who do
not obtain authorizations may be penalized by payers. If the claim is denied it paves
the way for animosities between provider and patient.
Medical practices need to act quickly and proactively to meet these challenges, while
still rendering high quality care and ensuring patient satisfaction. Medical
transcription services are available to help with clear and complete provider
documentation in the EHR for conveying medical necessity to the prior authorization
vendor. Partnering with an insurance verification and authorization expert can go a
long way in managing prior auths smoothly.

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• EHR data entry burden and time demands: EHRs have improved patient care
delivery and outcomes, but physicians are struggling to handle the data entry
demands of these systems. Many surveys have found that patient care is
compromised with the average physician spending a significant part of the patient
encounter performing EHR data entry.
A December 2017 Medical Economics report cites a primary care physician who says
that the solution lies in hiring scribes. Scribes help physicians transcribe the
physician-patient encounter in the EHR and update the patient’s records since the
last encounter. Scribes also document procedures performed in the office, new
imaging and/or laboratory results and any notes from outside physicians.
Outsourcing EHR-related documentation tasks to an experienced medical
transcription company is another practical option.
• Electronic alert overload: Physicians are overburdened with automated alerts. PCPs
who refer patients to labs for lab and imaging tests receive automated notifications
and alerts. Physicians may end up receiving irrelevant popups and even alerts about
tests they have not ordered.
EHRs also include numerous automated alert systems tied to patients’ health
information. An article in the Washington Post points out that these alerts have
become unmanageable, driving over-caution, and are overwhelming physicians. The
article notes that EHR vendors are working to ensure that their systems include only
targeted, relevant signals rather than meaningless generic alerts.
• Burden of benchmarking: The aim of benchmarking or setting institutional goals is to
improve patient care while reducing costs. However, benchmark-driven decisions
may not have the desired effect and could even make things worse. Speaking to
Medical Economics, a paediatrician pointed out how benchmarks can lead to over-
prescription of opioids because physicians are trying to comply with regulations
related to the “unrealistic goal of getting pain to zero”.

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A Beckers Hospital Review report cited the instance of a health system that reduced its
nurse workforce as a cost-cutting measure. The decision had unintended consequences in
that the physicians at the hospital had to perform tasks done by the nurses, such as taking
vitals and bringing patients to rooms. This led to a decline in physician productivity and
decreased patient access.
Such unintended consequences suggest decisions should be not be only
benchmarks.
• Regulatory burdens: One of the main reasons for physician burnout is the regulatory
burdens that providers face. The American College of Physicians recently reported
on a new Medical Group Management Association nationwide survey which found
that physicians find new rules and regulations frustrating. The respondents said that
that regulatory hurdles and duplicative processes seem to put paperwork before
patients. The key findings are as follows:
o 86percentbelieve that regulatory burdens overall increased in the past year,
and 79 percent, that their overall burden due to Medicare also increased.
o The respondents identified the biggest burden as the Quality Payment
Program (QPP), which created two payment pathways for physicians treating
Medicare patients – the Merit-based Incentive Payment System (MIPS) and
Alternative Payment Models (APMs).
o 55 percent of physician respondents said that there is no APM that is
clinically relevant to their practice.
o 76 percent of the respondents said the QPPhas not improved the quality of
care for patients, with 90 percent saying it has increased the regulatory
burden on their practice.
Shari Erickson, vice president for governmental affairs and medical practice for ACP
advocates team-based care as a potential solution. Erickson suggests that the value
based model can promote collaboration and sharing of best practices which would
reduce provider burden and improve job satisfaction, even if burdensome
requirements exist.

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The ACP says it is moving forward to overcome the challenges related to the APMs and
prioritize patients over paperwork. As patients and paperwork compete for their time,
physicians can continue to rely on medical transcription outsourcing to manage their
burdensome EHR documentation tasks.