Think that administrative burdens are hurting your ability to provide the best possible care? You're not alone: results of a recent APTA survey of physical therapists (PTs) nationwide reveal that nearly 3 in 4 believe that overreaching documentation and administrative mandates negatively affect patient outcomes—and 8 in 10 point to excessive requirements as a contributor to clinician burnout.
The results are now part of an infographic that helps with the association’s efforts for legislative and policy changes to rein in excessive requirements around areas including prior authorization and claim denial appeals. Among the findings:
Prior authorization requirements delay care and affect clinical outcomes.
- Three quarters of respondents said that prior authorization requirements delay access to medically necessary care by 25% or more.
- 72% of survey participants estimated that they wait at least 3 days for a prior authorization decision from an insurer.
- Just over 1 in 4 respondents said that the wait time is usually more than a week.
- Approximately 3 in 4 PTs agreed or strongly agreed that prior authorization requirements negatively impact patients' clinical outcomes.
Claim denial appeals are time-consuming (and often contradictory).
- 40% of respondents told APTA that payers who say they don't require prior authorization later deny approximately 25% of claims for lack of prior authorization.
- 65% of PTs said that it takes more than 30 minutes of staff time to prepare an appeal for 1 claim.
- When it comes to rates of claim denials, appeals, and final dispensation, respondents estimated that 13% of filed claims are denied; of that 13%, 66% are appealed. And in the end just over half of the appeals—52.34%—are overturned.
Administrative burden is adding to cost—and burnout.
- The survey revealed that large percentages of both front desk staff and clinicians spend more than 10 minutes per patient requesting approval for continued visits, ranging from 64.6% of clinicians working with Medicaid fee-for-service beneficiaries, to 77.3% of front desk staff requesting continued visits for Medicaid managed care patients.
- More than three-quarters of facilities—76.5%—reported that they've had to add nonclinical staff to handle administrative burden.
- 85.2% of respondents agree or strongly agree that administrative burden contributes to clinician burnout.
As for what changes would make the most difference, just over half of respondents believe that standardizing documentation requirements would be a big help. Other popular adjustments were elimination of the requirement for the Medicare plan of care signature and recertification (38.8%), standardization of coverage policies across payers (38.1%), unrestricted direct access (36.1%), and standardization of the prior authorization process (36%).
"APTA has long argued that excessive administrative burden negatively impacts care—what's important about this survey is the consistency of responses and the level of shared perception among PTs who experience this issue every day," said Kara Gainer, APTA director of regulatory affairs. "Administrative burden isn't a nebulous issue for providers—it is a very real barrier to delivering care, with identifiable pain points and very specific areas in need of change."
The association continues to place the reduction of administrative burdens high on its advocacy list and has again identified the issue as among it 2019-2021 public policy priorities. One recent opportunity: a request for information (RFI) from the US Centers for Medicare and Medicaid Services (CMS) on reducing administrative burden. APTA will provide comments by the August 12 deadline and has made it easy for individual clinicians to submit comments by way of a template letter that can be personalized to suit specific circumstances. APTA is also developing a template letter that can be used by patients and will post a link to it on the association's regulatory "take action" webpage.
At the same time, a legislative advocacy opportunity emerged in the form of a congressional bill aimed at improving access to health care for older Americans through, among things, reducing administrative burdens on providers. Known as the "Improving Seniors' Timely Access to Care Act of 2019," (H.R. 3107), the bill was introduced into the US House of Representatives by Reps Suzan DelBene (WA), Mike Kelly (PA), Roger Marshall (KS), and Ami Bera (CA). APTA staff will add information to the Legislative Action Center in the coming weeks for members to use to advocate in support of this legislation.
“Current prior-authorization programs hinder patient access to medically necessary services and must be modified,” said Katy Neas, APTA executive vice president for public affairs. "But this is just 1 element of the wider administrative burden issue, and APTA will continue to advocate for change on multiple fronts."