National Level:
Tri-organizational Workgroup Established to Inform the Design of Interventions to Reduce Burnout and Promote Professional Fulfillment Among U.S. Physiatrists
Physician burnout and its corollary, physician wellness, is a major challenge for physiatrists across all practice areas and settings. Physiatric leaders are aware of the data that demonstrates our specialty has one of the highest rates of burnout, dissatisfaction and unhappiness.
Burnout in medicine is commonly defined by the following three criteria:
- Emotional exhaustion
- Depersonalization (cynicism or callousness)
- Loss of personal accomplishment (lack of work fulfillment)
These combined detrimental effects raise serious alarms relating to individual physician health and well-being; specialty cohesiveness including recruitment, retention and reputation; as well as organizational growth potential.
New Collaborative Research Study
The aggregate PM&R responses from prior research do not drill down into the specialty enough to assist in identifying actionable interventions. Therefore, to gain further insight into the causes of burnout in physiatrists, AAPM&R, the American Board of Physical Medicine and Rehabilitation (ABPMR) and the Association of Academic Physiatrists (AAP) have entered into a collaborative project to address these issues. The tri-organizational effort will initiate and fund a research project—designed and conducted by the Stanford Medicine WellMD Center—to identify both cross-cutting issues as well as PM&R-specific drivers of burnout that can be translated into actionable and impactful interventions by the partnering organizations. Read more.
Major Advocacy Initiatives:
Prior Authorization Reform
AAPM&R has been working to reform prior authorization for several years due to the burden it puts on physiatrists and the barriers to rehabilitation care it creates.
What does AAPM&R prioritize in prior authorization reform?
- The lack of transparency with plans using proprietary guidelines
- The flaws of the “peer-to-peer” system
- Decreasing lengthy response times from plans conducting authorizations
What is AAPM&R doing to advocate for prior authorization reform?
- Advocating for the Improving Seniors’ Timely Access to Care Act, legislation to reform and streamline the prior authorization process under the Medicare Advantage program, since before its original introduction in the 116th Congress.
- Please see the Regulatory Relief Coalition’s website for more information on the progress of this bill.
- Advocating for the U.S. Congress to consider additional prior authorization reforms, including:
- AAPM&R-endorsed legislation to implement a Gold Card program under the Medicare Advantage program.
- Consistently meeting with the Centers for Medicare and Medicaid Services (CMS) and other Administrative agencies to discuss AAPM&R's priorities on prior authorization reform and reducing physician burden.
Recent advocacy efforts by AAPM&R on this issue include:
Additionally, please note the running list of comment and sign-on letters at the bottom of this page, which include many public statements from AAPM&R, as well as coalitions that AAPM&R participates in, advocating for prior authorization reform.
IRF Review Choice Demonstration (RCD)
CMS has begun to implement a “Review Choice Demonstration” (RCD) for Inpatient Rehabilitation Facilities (IRFs), which subjects selected IRFs to 100% pre-claim or post-claim review of their Medicare claims. While this demonstration has begun with all IRFs in Alabama, CMS is planning to eventually expand the RCD to all providers in four Medicare Administrative Contract (MAC) jurisdictions, covering 17 states, three U.S. territories, and the District of Columbia. CMS has publicly announced that while there is no set timeline yet, this program will next expand to Pennsylvania, Texas, and California.
AAPM&R has significant concerns with the IRF RCD project and has been a leader in opposing its implementation. This project will dramatically increase physician burden in a field already subject to onerous documentation requirements and serve as an unprecedented intrusion by CMS contractors in the exercise of independent physician judgment.
Recent advocacy efforts by AAPM&R on this issue include:
Please click here for more background on AAPM&R’s engagement on this issue when this program was first announced by CMS.
Additionally, please note the running list of comments and sign-on letters on this page, which include multiple comments on the IRF RCD.
Major Advocacy Win! Removal of Post-Admission Physician Evaluation (PAPE)
On August 4, 2020, CMS decided to remove the post-admission physician evaluation (PAPE) documentation requirement, effective October 1, 2020, as part of its Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule for 2021.
AAPM&R has long advocated to reduce burden for physiatrists by streamlining administrative documentation. Since 2013, our Health Policy and Legislation Committee has been advocating to revise redundant documentation requirements in IRFs, between the pre-admission screening, the previously required PAPE, and individualized overall plan of care (IPOC). IRFs have more documentation requirements than other settings and IRF admissions are often deemed unnecessary by Medicare auditors based on technical errors in documentation, rather than the patient’s actual medical need for an IRF admission. With one fewer documentation requirement in IRFs, physiatrists will be able to spend more time caring for their patients rather than ensuring redundant documentation is completed in tight timelines.
CMS’ decision to remove the PAPE is a direct result of our persistent advocacy.*
As proposed, CMS also codified into regulation certain elements of the pre-admission screening (PAS); however, they have removed three elements from the Medicare Benefit Policy Manual including expected frequency and duration of treatment in the IRF, any anticipated post-discharge treatments and other information relevant to the patient’s care needs.