Jeff Bendix is the senior editor of Medical Economics.

Jeff Bendix

Doctors and health care organizations know the importance of 

 in determining patients’ health outcomes, but they often are frustrated by their inability to securely exchange this information in 

 and integrate it into patients’ electronic health records.

CyncHealth, which comprises the state health information exchanges (HIEs) for Nebraska and Iowa, began taking steps in 2020 to address that problem. CyncHealth partnered with Unite Us, a technology company that builds networks of health and social service providers, to provide 

 and social health information on the HIEs. 

® sat down recently with Jaime Bland, D.N.P., RN, president and CEO of CyncHealth, to learn more about the program. The following transcript was edited for length and clarity.

How did this initiative get started? What was the impetus behind it?

Jaime Bland: I started my career as (a registered nurse), so I have a background in care coordination. When I came to the HIE I really wanted to incorporate the data that nurses and care coordinators working in the community need to leverage for better patient outcomes. That led me to onboarding various social care strategies, which is where we began to partner with Unite Us, to really facilitate that whole person picture of health.

ME: Why is it important to include social health data in information exchanged among clinicians?

Bland: We’ve long known that the social care category — housing, transportation, food, utilities — has an impact on health care outcomes. Knowing this information about an individual enables us to inform our clinical decisions when patients are ready to leave the hospital or to make recommendations on nutrition or even look at access to care. These components around social determinants influence how we care for patients as clinicians as well as make decisions about how we discharge patients from hospitals.

ME: How’s it going? Is there any evidence that it’s helped individual patients or on a population level?

Bland: A lot of these platforms are immature. The recent entry into the market of social care platforms, vertical integration, brings that data into the EHR; it really just entered into the United States Core Data for Interoperability, which is what codifies those data standards in the EHR. That was just finalized in 2021in the interoperability rules to include those social care components.

As we’re working through the technology and integration components, I would say that we’re early. This is very similar to how we rolled out computerized order entry
20 years ago, and it’s how we began to understand the wor flows and data standards and the need for extracting information once we enter the information.

I think it’s very much still in the early stages of integration into health care. Merging social care with health care is challenging. We know this just from the manual processes we have in place today. The approach to codify the data standards and build out work flows that meet both health care and community needs is a huge task. We’re two years into it. We’ve learned a lot from it, and we’re adapting and modifying. We brought in United Way and 211 as partners in community engagement, and one of the things we’ve taken away is the community convening piece, which I think fits very nicely with HIEs. We’re a neutral convenor. We’re trying to facilitate interoperability as well as building a longitudinal record that follows the person, so it really made sense for us to take a lead role in convening the community, agnostic to health system and agnostic to vendor, and leverage other community data collection points into one work group.

ME: Who identifies the need for addressing a patient’s behavioral or social health needs in the first place? Is it the primary care provider (PCP)?

Bland: It can come from a number of sources. It can be the PCP or the care manager or even the person checking in a patient at the front desk — for instance, the patient mentions they had a difficult time getting to the appointment because they didn’t have transportation. Those are things we don’t think about as relating to the clinical encounter, but they definitely affect whether someone has access to care or can get from the doctor’s office to the pharmacy or back home. Those are things that we’re bringing in as automated ways to create those referrals and then have that closed loop. Knowing that you referred someone for transportation or utility assistance is one step, but if you know that need was met, the next time you see that individual you have a better sense of how they’re managing their health. That’s what really drew us to a closed loop referral system.

I remember being a nurse and somebody identified a patient need at 4 p.m. on a Friday and thinking, “Who am I going to get to answer the phone at 4 p.m. on a Friday to ensure that this need is met over the weekend?” I would have loved to have a system that sent me an alert that the need was met and I didn’t have to track down someone on Monday morning to check.

So I think that’s very appealing to doctors and care coordinators when sending patients back into the community.

ME: It sounds like what you’re describing is compiling a 360-degree picture of a patient, whereas up to now we’ve only been seeing the clinical aspect.

Bland: Absolutely. That’s where the more expanded longitudinal view of health really comes into play by connecting those episodic touchpoints with health entities and bringing in those social care and community aspects. We all know the studies showing 80% of a person’s health outcomes are based on their social determinants. And that’s why we’re trying to connect the (social determinants) piece for a true health picture and connect the health care components to that longitudinal record as well. This will provide a new picture of what health looks like in a digital way, which is the goal of the longitudinal health record and what we felt was our place as the HIE.

ME: I want to talk more about those small practices in rural areas. How do they find out about services their patients may need?

Bland: That’s one way we are democratizing these applications and where we saw our role as an HIE to provide those applications to providers. In those one- and two-doctor practices, being able to use a system such as this is probably not financially feasible. But at scale we’re able to provide these applications at nominal cost, working with our largest health systems and our state partners and payers to bring not only the social care platform but event notifications and other applications that normally wouldn’t be available financially to providers in small practices and organizations.

ME: Many small communities lack the network of services to help these people. What do doctors in those places do?

Bland: One thing about Unite Nebraska is that myriad resources are available in that repository, so they can look outside of their own communities if they’re lacking resources patients could be referred to.

Additionally, it provides us insight as to where those gaps are. If needs are going unmet, those are data points we can now bring to our state legislators and say these are resources that are constantly being referred and where the need goes unmet, and we have a solid data. It’s really where a lot of these conversations started because we know those gaps exist in behavioral health and housing insecurity and food resources. So this is also a way for us to bring those data to light so we can have those policy conversations and have data-driven information to give policy makers and appropriators so they can direct resources to the appropriate places.

ME: Is securing and transmitting social data any different than how you handle clinical data?

Bland: Who needs to know about social care is different than who needs to know about clinical data. How we present that information in our longitudinal record is “a housing referral was made.” Some of the details about the encounter will be stored differently and will be visible differently to a provider than, say, the person who was providing the service. So those two things are differently represented in our system and that’s where it’s important to have some understanding of clinical protections and privacy laws versus social care. The more that comes into data standards, the more we can apply the same levels of protection as HIPAA (Health Insurance Portability and Accountability Act).

Privacy and security are top of mind. We have many points of security, layers of security, as well as governance. In Nebraska we have the HIT board, which is ensuring we’re meeting compliance standards for security, and it’s all open meetings. The other thing is we have broad participation in compliance and governance committees, and the data requests that come to us are made visible to our data suppliers.

I think there’s a robust governance in place that meets industry standards for sharing of information, HIPAA requirements, looking at the changing policy considerations from the 21st Century Cares Act into the interoperability rules. All those things are part of our organization and our mission around governance and transparency.

ME: What’s been the response from providers?

Bland: This is a new technology, so we have typical patterns of adoption — early adopters, intermediate adopters and the laggards. There are some health care systems with robust value-based care programs. They are the early adopters. They want to codify the work flow, bringing those data back from the community, having those alerts and flags for their care managers.

We’ve had some good uptake in rural counties because they do a lot of phone calls, so this is an automated way for them to send out a broad notification that they have an issue that needs to be addressed or referral that needs to be made without tying up a clinical person making 30 phone calls to find a resource to meet a patient’s needs. But for the most part we’re still working on adoption to get those intermediate adopters and laggards onto the platform.

ME: Did you encounter any resistance from clinicians or institutions? If so, how did you overcome that?

Bland: There’s a lot of persuasion that needs to happen. We’re not replacing anything currently in place. This is a technical enabler. But because it’s new, it’s seen as a threat to established turfs. And that’s where the community convening component is important. It’s a lot of meetings and socializations around how we’re trying to link services together.

There’s always comfort in doing things the way they’ve always been done. But I think if we’re going to make data-driven decisions around human services and truly address cost and quality issues from a state-wide perspective, these are the kinds of systems we need to implement.

Most of what we know about referrals and outcomes is anecdotal because many locations don’t have the ability to link the outcome to the individual. Until we do, we have to rely on aggregate information from claims data and we don’t know whether social and human services in the area actually affect outcomes in a data-based way.

Articles

When housing, transportation and other nonclinical data are shared electronically, clinicians can better understand their patients’ needs.

Integrating social determinants of health into health data exchanges

Although it’s been 30 years, pediatrician Maria Chandler, M.D., MBA, can still recall when she realized she needed to learn about the business of medicine. Soon after landing her first job, with TCC Family Health in Long Beach, California, she told the clinic’s CEO she wanted to gain some administrative experience. The CEO responded by asking Chandler to attend some committee meetings of the hospital with which the clinic was affiliated.

“I was shocked at how physicians were regarded, as if we didn’t know anything about the business side,” she recalls. “So I decided that if I want to be a leader and fight for physicians I’d better do something about this and get an education. I’m going to come to the table with the same credentials [hospital administrators] have and then they’ll have to listen to me.”

Chandler enrolled in an MBA program at Pepperdine University’s satellite campus in nearby Irvine, taking classes two nights a week while continuing to work full time. Four years later, she emerged with a degree — and a better grasp of the challenges the hospital faced.

“I realized those administrators knew what they were talking about,” she says. “At the same time, I found I was being treated with more respect at the business meetings and I have been ever since. I couldn’t be happier I got that degree.”

Doctors have always known that practicing medicine includes a business component; they can’t treat patients unless they earn money. But when most physicians 

 or in small groups it was enough to know the basics of practice finance and hire a practice manager and/or accountant to look after the rest.

As medicine grows increasingly corporatized, however, more doctors are finding that being able to read a balance sheet or profit-and-loss statement is no longer enough. Whether they work for a hospital system or own an independent practice, they are realizing they need to understand the language, concepts and skills taught in MBA programs to be able to advocate for their patients, advance their careers — or just remain in business.

“You can’t do health care without the business piece, just like the business piece can’t exist without the clinical,” says Timothy Switaj, M.D., MBA, a U.S. Army colonel who oversees health care delivery for Army and Air Force personnel in the San Antonio region.

While the number of doctors with MBA degrees is unknown, several signs point to a gradual, though uneven, increase in interest among physicians in obtaining both degrees. For example, there were fewer than 30 joint M.D./MBA programs operating in 2000, according to 

 That compares to 60 such programs now listed on the Association of M.D./MBA Programs 

. In addition, 14 schools offer joint DO/MBA programs.

The Association of American Medical Colleges reports that the number of graduates from combined M.D./MBA programs rose from 61 in 2003 to 148 in 2016, a 142% increase. But after peaking at 974 in the 2017-18 academic year, enrollment in these programs dropped to 644 in 2020-21.

Physicians generally take one of three paths to an MBA degree. The first is by enrolling in a full-time MBA program while also practicing full time, as Chandler did. A second path is to obtain an MBA at the same time as a medical degree through a program operated jointly by a medical and business school, where students alternate between the two.

Joint-degree students at the University of Southern California (USC), for example, begin by taking two or three years of classes in the Keck School of Medicine followed by a full year of classes at USC’s Marshall Business School. The rest of their time at the university is spent completing their credit requirements for both degrees.

Independent medical schools, or those that are part of a university without a business school, sometimes will offer joint degree programs with a nearby one. Students at the Philadelphia College of Osteopathic Medicine (PCOM), for example, can take MBA classes at Saint Joseph’s University’s Haub School of Business.

The third approach to earning an MBA is through an executive program. Unlike a full-time program, executive MBA programs are geared more toward working professionals, with most classes held on weekends. That’s what appealed to internist Darren Sommer, DO, MBA, when, after five years as a hospitalist at a regional medical center in North Carolina, he enrolled in the executive MBA program at Duke University’s Fuqua School of Business. Students attended weekend-long classes at Fuqua every other weekend for two years and did coursework on their own in between.

“It was a great experience because I was directing the hospitalist program and I could come back and implement some of the things I learned in my classes right away,” he recalls. “The other good part was that I was interacting with people from all over the country who had similar backgrounds and challenges to what I was facing so we were able to learn from each other.”

Like many other professionals who return to school, Sommer found it challenging to balance the demands of coursework with job and personal life — in his case, a medical practice and a family that included three small children. “It’s kind of funny, because when you’re doing it it’s like, I never knew I could cram this much stuff into my life, but you find a way to make it work,” he says.

The pros and cons of a dual M.D./MBA degree

Each approach to obtaining a management degree at the same time as earning an M.D. or D.O., or while already in practice, has benefits and drawbacks. One advantage of joint programs is that students usually can complete the MBA component in less than the two years required in most stand-alone MBA programs. At USC, for example, students take only 48 credits rather than the normal 63, says Evan Bouffides, assistant dean and director for MBA admissions at the Marshall School.

“In a sense, any dual-degree student cuts short the amount of time and cost by one full year compared to students who pursue the two degrees independently of each other,” he says.

Italo Subbarao, DO, MBA, dean of the College of Osteopathic Medicine at William Carey University, says earning the degrees simultaneously (through the PCOM/Saint Joseph’s joint program) enabled him to understand systemic trends in health care better than many of his colleagues when he began practicing.

“It was a time when things like managed care and hospital consolidation were coming into play, and because of my MBA I could see what was coming next and started thinking about things like value-based care and quality outcomes,” he says. “The MBA allowed me to see these things a little sooner than the people around me.”

Studying for an MBA can also better prepare medical students for 

, Subbarao says. “You look at residencies a little differently because you have a better understanding of the system you’re about to enter,” he explains. “You might find a program you’re better aligned with because of what you learned through your MBA program.”

On the other hand, getting an MBA after being in practice a few years can yield more immediate benefits, say those who’ve chosen that route. “I think physicians who do executive MBA programs have a much richer experience because they’re able to implement some of the concepts they learn right away,” Sommer says.

Todd Shaffer, M.D., MBA, a family practitioner at the Truman Medical Center in Kansas City, decided to get a business degree in 2004 after being named residency director for the University of Missouri-Kansas City School of Medicine, which is part of the Truman Center.

Shaffer enrolled in a program at Rockhurst University that included practicing physicians and residents as well as medical students who were pursuing a joint degree. He noticed a difference between the two groups, especially in the projects students developed and worked on as part of their coursework.

“We [doctors and residents] were using our projects in our clinical settings as we were doing the course,” he recalls, “whereas the medical school students didn’t have the experience to use what they were learning, and if you don’t get to use something right when you learn it you tend not to remember it, versus if you learn something today and use it tomorrow, it’s probably going to stick with you.”

Shaffer found the program’s focus on developing leadership skills particularly useful. “We spent a lot of time figuring out what kind of leader we were. That was very useful because it helped me figure out what I’m good at and not so good at, then how to get better at some of those things,” he says.

While physicians and program administrators cite a variety of reasons why doctors obtain MBAs, they generally fall into three broad, often overlapping categories: to improve their management skills, to advance in an organization and to gain a better understanding of health care policy. The latter was Sommer’s motivation for seeking the degree.

, and I had some pretty strong opinions about it,” he recalls. “But when I’d go to Washington to talk to congressmen, I quickly realized that having a medical degree wasn’t enough to participate in the debate. I needed a better business and policy understanding of health care to make my arguments more effective.”

Switaj credits the MBA and MHA degrees he earned through the Army-Baylor Graduate Program in Health and Business Administration with advancing him from chief medical officer at an Army community hospital to his current position as director of clinical operations and chief medical officer (CMO) for the Army’s San Antonio region.

“I always knew I wanted to get into a physician leadership role where I could explain the business piece to the clinicians and the clinical piece to the administrative staff,” he explains. “I was able to do that at lower levels, but when I got to the CMO level I realized I had a knowledge gap I would need to fill if I wanted to move up.”

Switaj says the skills he learned in the Army-Baylor program enabled him to better align the Army’s primary care resources in the San Antonio region with the places they were most needed. He also became proficient at using the spreadsheet program Excel to present data. “When I have to answer questions from my superiors or explain things to my staff, the ability to organize and interpret data and create charts and tables so they could better understand the data has been a masterful tool.

“I don’t think at any level you can completely separate yourself [as a physician] from the business side,” he adds. “Having the MBA provides that ability to speak the same language and help you better understand why some decisions are made, even some you may not agree with.”

A third reason doctors obtain MBAs is to better understand the management side of their own practice. That was the goal of Nathan Granger, M.D., MBA, when he enrolled in Rockhurst’s part-time MBA program in 2005. A decade earlier, Granger had co-founded Clay Platte Family Medicine Clinic in Kansas City and realized he needed more than on-the-job training to keep up with the rapidly growing practice’s needs.

Having an MBA, he says, helped Clay Platte in a variety of ways. The human resources and organizational behavior knowledge he acquired enabled the practice to identify and hire an administrator that matched its needs, ending the churn it had experienced at that position. “Normally for a small practice to hire a high-quality administrator is very difficult,” he says.

With the financial understanding he gained, Granger was able to prepare and present monthly updates on Clay Platte’s finances, a practice he continues to this day. He now also chairs the finance committee of the clinically integrated network to which Clay Platte belongs.

But the most important takeaway from his MBA experience, Granger believes, was to broaden his perspective on what it means to be a doctor. “I came to see that physicians don’t just have a responsibility to an individual patient,” he says. “We also have obligations to the health of our communities. That’s a basic tenet of being a physician.”

Granger’s MBA helped him meet those obligations by learning to work within and lead the network of doctors, practices, hospitals, payers and other organizations behind the treatment of an individual patient. “Being able to work with all the different players in the health care system requires leadership,” he says. “And what better person to provide that than a doctor with an MBA?”

While many doctors with MBAs say they have benefitted from getting the degree, not everyone thinks it’s a good idea. David Zetter, CHBC, CPC, principal of the practice consulting firm Zetter Healthcare, goes so far as to call it “a waste of money.”

“An MBA will teach you about management, but it doesn’t teach you how a medical practice is run,” he says. “There are too many things that happen in a medical practice that have nothing to do with courses taught in an MBA program.”

He cites revenue cycle management as an example. “It’s the most important aspect of a medical practice but they don’t teach anything about billing, collections, follow-ups, what are the best policies and procedures. None of that is ever discussed in MBA programs.”

Getting an MBA also creates the potential for conflict with practice administrators. “I’ve got a situation now where the practice administrator is butting heads with a doc [with an MBA] who keeps sticking his nose in,” he says. “It’s gotten to the point where one of his partners said ‘why don’t you quit being a doctor and become our administrator if you think you can do it better?’”

Zetter acknowledges his biases stemming from his own work as a practice consultant and his position as president of the National Society of Certified Health Care Business Consultants. “I’m not saying all MBA programs are bad, but you have to do due diligence,” he says. “Ask yourself, ‘Why am I taking this program?What do I expect to do with an MBA degree?’ And ask other doctors with MBAs what specific aspects of their practice do they better understand because they got that degree?”

He adds that doctors, even those with an MBA, should not try to run the business side of their practice. “You’ve gone through 13-plus years of school to become a clinician and generate revenue. If you’re going to spend time also being an administrator you cut down on the time you can generate revenue,” he says. “So do you want to see patients and generate revenue or do you want to be an administrator? Because you can’t do both.”

As medicine grows increasingly corporate, doctors are finding that career advancement requires understanding the business side of the profession

Is an MBA right for you?

I wish I could do more paperwork,” said no doctor, ever.

Tasks such as filling out forms, checking boxes and fighting with insurance companies have long irritated physicians. But several trends have converged in recent years to bring what had been simmering discontent over administrative and regulatory burden to a boil. Chief among these are the spread of electronic health records (EHRs) and their accompanying documentation requirements, and the growing number of procedures and medications requiring prior authorizations.

Then, in 2020, the brew of physician frustration grew even more toxic with the arrival of COVID-19. Suddenly, doctors found themselves confronted with a whole new array of health and safety mandates, along with needing to reconfigure their practices to care for patients remotely rather than in person.

The impact of paperwork, regulatory burden

Given these developments, it’s hardly surprising that “too much paperwork and regulations” was the leading cause of burnout cited in the 2021 

® Physician Burnout and Wellness Survey. Similarly, 91% of those surveyed by the Medical Group Management Association (MGMA) for its 2021 regulatory burden report said their overall regulatory burden had increased during the previous year — up from 86% in 2018 and 2019.

But even if some administrative tasks are unavoidable in fee-for-service medicine, practice consultants and management experts say there is still much doctors can do to reduce their share of the paperwork load and free up more time for seeing patients.

One of the biggest sources of paperwork and administrative tasks is the EHR. Numerous studies have documented EHRs’ impact on the amount of time doctors spend with patients and their overall workloads. For example, a 2016 study of 57 doctors’ daily activities published in 

 found that physicians spent 49% of their total time on EHR and desk work and only 27% on direct clinical face time with patients.

“The EHR has been and continues to be a huge source of added time and frustration for physicians,” says Adrienne Lloyd, MHA, FACHE, founder and CEO of consulting firm Optimize Healthcare and a former MGMA practice consultant. “Most of them understand the need for it from a medical perspective but it’s not a value added from the patient perspective.”

EHRs actually pose three separate, interconnected challenges for physicians in outpatient practices, according to Ron Holder, M.H.A., MGMA’s chief operating officer. First is their lack of user-friendliness, a flaw arising from the fact that they weren’t originally designed for medical purposes.

“A lot of EHRs are really billing systems disguised as a medical record,” Holder explains “So if the technology is designed for simplification of the billing process, that rarely translates into ease of use when working with it clinically.” And while vendors have made some progress in correcting this, many users still find them difficult to navigate and counterintuitive and resent the additional hours of charting they create.

The second problem, says Holder, arises from the frequent mismatch between the needs of outpatient primary care practices and their parent hospital system. “If you’re part of an integrated delivery system it’s likely that the people making the purchasing decisions are buying an EHR that looks good for a hospital, but that often doesn’t translate into being user friendly for an outpatient practice,” he says. “When you take a product that was designed to do X and try and make it do Y it’s going to cause a lot of frustration.”

Finally, when selecting an EHR system many practices don’t consider how it’s going to affect their workflow. “They mistakenly think they can beat the EHR round hole into the square peg of how they’ve always practiced,” Holder says. Ultimately, he adds, most practices find it’s better to tailor their workflows to fit the EHR rather than the other way around.

“You have to be willing to use the tool how it’s supposed to be used,” Holder adds. “It stinks at the beginning, but it gets much easier later on.”

So what can primary care doctors, and the practices that employ them, do to ease some of the administrative burdens caused by EHRs? A good place to start, and one that’s been growing in popularity, is to use scribes to document patient visits. In a 2018 

 study, 69% of PCPs using scribes reported spending an hour per day less on EHR documentation compared with those not using scribes, 94 % reported greater job satisfaction and 89% reported improved clinical interaction with scribes present.

While some practices balk at the cost of hiring scribes, in many cases they pay for themselves through time savings and added efficiency, notes Owen Dahl, MBA, CHBC, principal of Owen Dahl Consulting. “If I can get, say, $70 for a (CPT code) 99213 established patient office visit, and a scribe allows me to see two more patients per day, then I’ve paid for that scribe,” he notes.

Another technique for improving EHR efficiency, according to Lloyd, is to build order sets and templates. The former consist of services the doctor routinely orders for patients when they reach a certain age or have a chronic condition.

“The EHR generates everything that’s needed (for those services) so the doctor doesn’t have to hunt for each one separately, which makes the process a lot easier for them,” she says.

In a related way, templates enable physicians to standardize and customize their notes, with different fields for vital signs and other things the doctor might want to check,again depending on the patient’s age, gender and chronic conditions. The EHR can then be programmed to use that information as the basis for a note. “So there are ways of building in some automation so the doctor doesn’t have to repeat the same step for each patient,” Lloyd explains.

Sometimes the biggest obstacle to implementing such shortcuts is the doctors themselves, Lloyd says. “It’s getting them to take the time to step back and look at what they do most often so you can build those templates and order sets for them. And it doesn’t take a ton of time; it’s just getting the providers to believe it will help them and getting someone to execute on those things from an IT perspective.”

The technical skills needed for configuring the EHR may require an outside consultant but sometimes a tech-savvy person already on staff is enough. “Even in a small practice often there’s at least one person who can help with configuring the system to what the doctors want and serve as a liaison to the EHR vendor,” she says. “If you’ve got that person it’s a nice opportunity for them to be helpful outside their usual role.”

Practices can enlist patients in the effort to reduce administrative burden, says Holder, by encouraging them to submit basic medical information online so it can be seamlessly entered into their electronic medical record.

“I read an article recently that said even motor vehicle departments are better than many practices at getting people to fill out this stuff before they come in,” he says. “When the DMV is being held up as an example you know you’ve got a problem.” Practices buying or switching EHRs can reduce headaches by learning as much as possible about the system in advance, Holder advises. That is best done by talking to other practices who use it. In addition, have vendor representatives spend time at the practice observing how it operates and its patient flow. “Ask them, ‘What would we have to do different in order to efficiently use your system?’” he says.

The time demands of prior authorizations are another source of frustration for many doctors. In MGMA’s regulatory burden report, 88% of respondents called prior authorization requirements “very” or “extremely” burdensome, up from 82% who used those terms in 2018.

But while prior auths may not be avoidable, experts say there are ways to minimize the burden they impose. One of the most effective, says Dahl, is to compile a running list of which procedures and prescription medications require prior auths from which payers, and under what circumstances. Such information usually can be obtained from the payer’s website and by calling them.

Sometimes, he adds, a payer’s prior authorization requirements will vary even from patient to patient, so it’s important to include the practice’s own prior auth requests and their outcomes. “Don’t just say, ‘We got the authorization’ and leave it at that,” Dahl advises. “Audit what happens with the denials and the authorization hassles encountered. Be aware of the documentation required and ask, ‘Are we providing that documentation and doing so in a timely manner?’”

Analyzing this information usually will clarify which procedures routinely need prior auths from which payers and therefore can be obtained without the doctor getting involved. “I suspect most practices would find the doctor is only needed in about 20% of requests,” he says.

But this process doesn’t relieve doctors of all prior auth responsibilities, Dahl adds. “There’s still some burden on the doctor to make sure what they’re ordering is adequately documented and that there’s sufficient information for the staff to take on the responsibility of communicating with the payer,” he says.

Holder says thorough documentation provides useful ammunition for the times when, even after submitting it, the payer requires a physician-to-physician phone call before it will authorize coverage. “That allows you to say to them, ‘The information is all there in my note. Why am I having to call about this?’” he says.

Holder adds that prior authorizations can become part of payer contract negotiations by, for example, specifying the circumstances under which the doctor does and does not have to get involved in the process. “You can make the argument (to the payer) that they’re limiting your ability to care for their patients by having to spend time on the phone with them,” he points out.

In addition to EHRs and prior auths, experts say doctors can reduce their non-clinical workload by delegating tasks that don’t require the doctor’s input — and ensuring staff members are trained to do them. Lloyd cites the example of assigning a staffer to take patients’ medical histories before they see the doctor.

“The staffer will need to know what information the doctor wants to have before walking in the room with that patient,” she says. “It’s all about allowing the provider to focus on the areas where they can have maximum impact.”

The ability to delegate effectively also requires strong bonds between doctors and staff, says Holder. “Then people are acting out of loyalty. They know you’re working to make them successful and happy and when that happens the team wants to take as much off the physician’s plate as they can.”

Don’t let administrative burdens wreck your practice