There needs to be a policy "reset" for physicians post-COVID, healthcare leaders say

Doctor computer medical records
Two physician leaders argue that several policy and practice changes that relaxed regulatory requirements during the pandemic need to endure after the crisis has passed. (Getty/BrianAJackson)

The COVID-19 pandemic offers an opportunity for a practice and policy "reset" to help permanently reduce administrative headaches for physicians, according to a commentary in published in Health Affairs.

During the COVID-19 pandemic, regulators and payers have relaxed or modified long-standing policies to ease documentation burdens for doctors. The Centers for Medicare and Medicaid Services (CMS) announced in early April a series of rules that aimed to remove regulatory burdens facing providers swamped with treating the COVID-19 outbreak.

At the top of the list of impactful changes is the waiver from CMS of policies regarding verbal orders.

For example, physicians are now permitted to verbally communicate to a nurse a patient’s need for a transfusion of one unit of blood, wrote healthcare leaders Christine Sinsky, M.D., and Mark Linzer, M.D., in a recent Health Affairs commentary.

"There has been a heightened receptivity to the importance of preserving physicians’ and other health care professionals’ time, cognitive bandwidth, and emotional reserve for the direct care of patients, instead of squandering these resources on low-value tasks and frustrating technology," wrote Sinsky, vice president of professional satisfaction at the American Medical Association (AMA), and Linzer, vice chair of the Department of Medicine at Hennepin Healthcare.

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The current pandemic offers some important lessons about how to reduce administrative burdens for doctors going forward and potentially alleviate physician burnout, Sinsky and Linzer wrote.

Beginning in April and retroactive to March 1, CMS took several steps to help providers such waiving credentialing requirements and telemedicine restrictions. CMS now allows payment for virtual visits to a broad pool of patients and these visits, performed by video or telephone, are reimbursed at levels consistent with in-person visits.

In a move that will provide paperwork relief to many physicians, CMS has also issued a waiver that eliminates the requirements for a physician signature to replace durable medical equipment that has been lost, destroyed, or otherwise rendered unusable.

In addition, CMS has waived several quality measurement reporting requirements in its Merit-based Incentive Payment System.

The relief from extensive administrative burdens during the COVID-19 crisis is already being felt, Sinsky and Linzer said.

"One health system leader describes a conversation with a primary care physician who had been feeling demoralized and burned out for some time, who said that 'it feels like we are practicing medicine again'," they wrote.

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Sinsky and Linzer argue that several policy and practice changes need to endure after the crisis has passed.

For example, the requirements for prior authorization should be more universally focused on prescribers who are outliers; those who have demonstrated trustworthiness in their choice of tests and treatments could be exempt or have expedited approval processes.

"Our call for a practice and policy reset is not a call for anarchy. Rather, this is a call for a reconsideration of the status quo—a call to relinquish some of the nonessential policies that are encumbering health care professionals," they wrote.

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In order to accomplish a policy “reset”, rather than reverting to pre-COVID practices, they outline six principles to help guide which changes should stay or be newly considered after the public health emergency:

  • There is a need for evidence-based policy and regulation to justify existing policies and future changes.
     
  • The assumption that a task is automatically safer when it is performed by the highest-trained practitioners should be avoided. This assumption actually risks a more hazardous care environment—for example, by increasing the odds that critical medical decisions will have to be made in states of frenetic multitasking as a physician performs multiple clerical tasks while also making critical clinical assessments.
     
  • Factor in that the financial cost of regulatory and policy requirements is often borne by the clinicians closest to the patient, and not by the organizations that financially benefit from them, such as insurance companies with prior authorizations.
     
  • The stance “if it wasn’t documented, it wasn’t done” should be abandoned. This dictum contributes to volumes of wasteful and distracting noise in the medical record and sets up the impossible expectation that the record should scale at nearly one-to-one with the care provided.
     
  • Policy and punishment should not be used as the only, or even the main, levers by which to drive quality and safety. Use approaches that feed into providers' intrinsic motivations of professionalism and a desire to serve.
     
  • The locus of responsibility for health care outcomes should be assigned appropriately. Accountability is often assigned only at the level of individual practitioners for outcomes that are also under the influence of either the systems in which they work or the overall health system, government, and culture.

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