As we all can attest, none of us got into the physical therapy profession because we wanted to do paperwork. That burden was actually the driving force behind starting WebPT: to make documentation easier for rehab therapists, so we could spend more time treating patients.
And yet for as far as we’ve come with technology, healthcare providers are still stuck bearing the weight of administrative burden. Technology has thankfully made it easier to do so many of the rote tasks required of healthcare professionals in a given day—and yet the broader healthcare system has responded by heaping more and more administrative work on our plates.
If we haven’t already reached a breaking point, we’re fast approaching it. Providers and staff are burned out, and many patients are struggling to get the treatment they need—all in service to a failing bureaucracy that is doing more harm than good. If we’re going to move rehab therapy forward, we must make changes to minimize the “administrative harm” we’re dealing with in our own practices—and believe me when I say that this is a priority at WebPT.
Too much admin adds waste to an already expensive system.
One of the biggest causes of concern within rehab therapy is the out-of-control healthcare costs our patients have to deal with. And while for-profit private insurance plays a big role in those cost increases, administrative waste is doing its part to drive up costs.
According to one study, administrative expenses account for 15 to 25% of all healthcare spending. Assuming a figure of $4.3 trillion in national healthcare expenditures for 2021, that’s over $1 trillion spent on administrative tasks. A separate report from the Organisation for Economic Co-operation and Development (OECD) puts the figure for administrative costs at 8% of U.S. health spending—better, but still five times higher than the average of other G7 countries.
Some of these costs are unavoidable—like managing facility finances, training staff, ensuring operational compliance, etc.—but there’s definitely some unnecessary and wasteful administrative work in there. In fact, according to this Health Affairs study, administrative waste could account for as much as 15% administrative spending in the US healthcare system, which works out to $150 billion. (And that’s without calculating a dollar figure for the time staff spends on these tasks.)
But wasted money is a bit of an abstract way to think about the problem, especially one that has a human cost. If we really want to grasp the harm that excessive administration is doing, we have to look at how it’s impacting the people who make up our healthcare system—in this case, rehab therapists and their patients.
What’s administrative waste really costing rehab therapy?
Administrators and executives have lost sight of the fact that health care is ultimately about skilled providers helping patients heal and recover; instead, PTs are increasingly asked to be clerical workers as much as caregivers, navigating through extensive documentation red tape in order to get paid. According to one recent study, the average physician spends nearly 17% of their working hours on administrative tasks, and about 16 minutes per patient on their EHR. And it’s not just clinicians—according to a survey conducted by the APTA, over 80% of rehab therapy front office staff are spending more than 10 minutes to complete a prior authorization per patient, and 65% spend more than 30 minutes of staff time on an appeal for a single denied claim. Add these burdensome processes to all the other administrative tasks required on a given day in a clinic, and it’s no wonder that burnout is a huge issue and we have had over 20,000 therapists leave our profession since the pandemic.
It’s creating too much work, and therapists are burnt out.
Rehab therapists and staff are doing what they can to keep up with the requirements, but our profession is suffering as a result of the workload. WebPT’s most recent State of Rehab Therapy report found that long working hours and burdensome documentation and regulatory requirements were the second- and fourth-ranked contributing factors to burnout among rehab therapists—no surprise to any clinician who has had to spend lunches, nights, and weekends with documentation as their companion. Similarly, this APTA survey found that more than 85% of respondents believe administrative burden contributes to burnout. We’re losing good therapists in part due to increased compliance requirements; worst of all, we’re creating a wall between ourselves and patients.
Administrative requirements are preventing patients from getting care.
It’s unconscionable that paperwork should stand in the way of people being able to see their healthcare provider, but that’s exactly where we are, as patients who need medical care have had significant administrative barriers placed in their path. There are countless patients who are prevented from accessing needed benefits and treatments due to the multiple steps they have to go through before they can see a healthcare provider. One study found that 24% of patients either delayed or skipped care due to administrative requirements, with a greater burden falling on those with disabilities and women—and those who are able to get in to see a PT might not be getting the outcome they could. In that same APTA survey, 74% of respondents believe that prior authorization requirements negatively impact patient outcomes. So when we’re starting to fail at the basic function of health care, it’s fair to say that we need to make big changes.
How can we address the problem?
If we want to tackle the problem of administrative harm, we must work together to advocate for regulatory changes that take some of the work off the shoulders of providers and front office staff. And we must ensure that the patient experience at our clinics is front, center, and free from as many administrative hurdles as possible.
Push hard for regulatory change.
If we’re going to survive and thrive as a profession, we’ll need to start putting people over profits by fixing current regulations so that they’re less burdensome—and get rid of the ones we don’t need. In other words, it’s time to nip compliance creep in the bud.
Legislation is in the works.
Fortunately, there’s already some measures in the works to alter existing requirements.
If you’ve lamented the significant staff time devoted to getting referring physicians to sign off on a plan of care, you’re in luck; the APTQI is proposing and advocating for a change to the Physician Fee Schedule that would reduce the requirements to either a referral or a certified plan of care, but not both. There’s also H.R. 3173, which would create an electronic prior authorization system for Medicare Advantage plans that would deliver real-time decisions, and H.R. 5688, which would require the Department of Health and Human Services to reduce the unnecessary costs and administrative burdens in the healthcare system by half over the course of a decade.
Any of these changes would give clinics that much more time to devote to helping patients rather than jumping through hoops. But, they won’t get written into law if we don’t do anything about it. We need to lobby for our own cause by writing and calling our legislators to voice our support for these laws, either individually or through the advocacy efforts of the APTA and APTQI, and by contributing to groups like PT-PAC, the AOTPAC, or ASHA-PAC that know how to play the game in Washington and can help move legislators to our side.
Prioritize the patient experience.
These macro issues may seem overwhelming, and it can be difficult to know where to start. But small things each day in your practice can make a big difference. Regardless of whatever challenges we’re dealing with as clinicians, we must put the patient experience as our top priority in how we operate our clinics. There’s been a strong focus on provider experience in the past few years—and with good reason—but the pendulum may have swung too far in this direction, and the patient experience has seemingly become less of a priority. With healthcare services getting more expensive and patients assuming more of the financial risk, they’re more apt to be selective in which providers they choose when seeking care. The PT experience must be as easy as possible for patients, starting with the administrative side of things.
And while technology can be a solution to reducing the administrative problem rehab therapists are facing, it needs to be technology that works together with your existing systems—and most importantly, works for you.
Weigh your “must-haves” against your “nice-to-haves”.
When you’re looking at software options, you must consider narrowing down to the problem you are trying to solve for your business. This of course can change year over year, so make sure you’re keyed into what your current specific needs are and where you’re hoping to go in the near future. Reconciling yourself to the fact that not every platform is going to have everything you want will help to focus on what the current priorities are for your practice. Creating a priority list of “must haves” and “nice-to-haves” before reviewing the software demonstrations are key to making the right decision for your business.
For example, to help solve administrative burden on the front office, I’d consider digital patient intake and electronic benefits verification to be “must-haves” for reducing patient wait times, streamlining the registration process (no clipboard required), and giving your staff time to focus on exemplary customer service. Scheduling software can also be worth its weight in gold as oftentimes these programs will send automated appointment reminders to patients, reducing the number of calls your staff typically makes in a day—and playing defense against your no-show rate. Additionally, a rock-solid RCM process can help prevent billing surprises for patients and keep your monthly A/R low.
If you keep an eye towards improving your practice’s efficiency, elevating the patient experience will be a natural and impactful by-product. Patient satisfaction is critical, and word-of-mouth is essential for garnering five-star reviews and keeping referring physicians happy. And while technology can support your patient experience objectives, it must be augmented with streamlined processes, a service-oriented company culture, and alignment as to what the ultimate patient experience should look like for your practice. Paired with a people-first culture, reducing administrative burden by selecting the right tools and technology to maximize both the patient and provider experience will always be a winning combination
The growth of administrative burden isn’t surprising given that healthcare has morphed into a big business over the past few decades. Unfortunately, too many people within that business have lost sight of what our primary focus should be: treating patients. Whether it’s new tech or new regulations, the focus needs to be on making the healthcare experience easier for both patients and providers.