By Sarah Bates, MBE, Government Relations and Research Analyst
MMS members meet with Senator Ed Markey, one of many lawmakers who work with the Medical Society on issues critical to patients and physicians. Photo by MMS Staff.
The physician burnout crisis is only getting worse. Advocacy is one of the Medical Society’s strongest levers for creating change. But how can we use that lever to fix this complex problem? Legislative solutions work best for problems that affect medical practice, but they are too broad-brush for addressing some physicians’ day-to-day issues. We can’t send state or federal legislators into hospitals to solve these workaday problems, but that doesn’t mean the Medical Society can’t address burnout through legislative advocacy. We must do so — not solely through encouraging the passage of standalone legislation — but also by encouraging lawmakers to consider the possible adverse consequences of all proposed legislation and regulations, state and federal, that increase administrative burdens for physicians without benefiting patients. This is the type of legislation we must advocate to amend.
Easing State Mandates
At the state level, the Medical Society has a long history of successful advocacy to reduce administrative burdens associated with statewide changes to health care systems. For example, several years ago, the legislature proposed requiring all physicians to adopt electronic health records (EHRs), without exceptions. The Medical Society recognized the burden that mandate would place on small and independent physician practices and worked with the Board of Registration in Medicine for a more reasonable interpretation, which included the option of a one-time continuing medical education course for physicians who do not regularly use EHRs.
More recently, the legislature proposed requiring that all physician practices connect to and regularly use the Mass HIWay to share electronic patient data. As with the earlier EHR mandate, this requirement would have compelled some small and independent physician practices to create unnecessary workflows simply to fulfill the requirement. In some cases, it might even have forced practices to close their doors. In response, the Medical Society advocated for a tiered implementation of required connection to the Mass HIWay, with an exemption for small physician practices.
The Medical Society is also part of a state coalition to address the issue of prior authorizations. We have joined with a sizable group of other organizations to protect Massachusetts patients from “fail-first” policies, which require that they first try a less expensive medication before “stepping up” to a more expensive drug. This is an issue of care access, but also one of administrative burden. We have heard from our members that prior authorizations have replaced EHRs as their most onerous day-to-day administrative burden. Overworked physicians cannot provide the high-quality care that they entered the profession to give.
Taking the Fight to Washington, DC
On the federal level, the MMS has consistently fought for administrative simplification for Medicare, including fewer reporting requirements and carve-outs from mandates for small physician practices. In August, the Centers for Medicare and Medicaid Services (CMS) released annual draft regulations on changes to the Quality Payment Program and the Physician Fee Schedule. CMS stated that one of its goals was to reduce administrative burdens through its “Patients over Paperwork” initiative. While many of the proposed changes were consistent with this goal, the MMS, along with the majority of national and state medical societies, successfully opposed other provisions, such as the collapsing of evaluation and management codes, which were ill-conceived and harmful to patient care.
Then in late January, the MMS weighed in on the role EHRs play in physician burnout through comments to CMS’s proposal on “Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and Electronic Health Records.” In his letter to CMS, MMS President Alain Chaoui, MD, suggested numerous ways to make health care IT help, not hinder, clinical workflow, including encouraging the development of artificial intelligence tools to support clinical documentation and quality measurements as well as incentivizing the adoption of technology that generates and exchanges standardized data, supporting documentation needs for ordering and prior authorization processes. The MMS has also joined with the AMA and other groups in opposing onerous prior authorization requirements in Medicare and Medicare Advantage plans.
In February, Massachusetts Medical Society physicians discussed physician burnout with the Massachusetts congressional delegation at the National Advocacy Conference in Washington, DC. Members of Congress and their staff were troubled to learn that burnout affects physicians of all ages and levels of experience, including trainees and early-career physicians. At some point, Congress may be asked to intervene to prevent the physician workforce shortages that are being predicted, should the problem continue unabated. The MMS delegation encouraged members of Congress and their staff to carefully consider the administrative burdens new laws could place on physicians as part of their deliberations.
