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Spring 2025
Spring 2025 Issue Clinical Matters: Balancing the Minutes Eliminating Time Management Barriers to Quality Care It’s a common complaint within geriatric medicine: Managing the growing volume and complexity of clinical documentation and staying ahead of escalating payer demands leaves scant time for direct patient care. What time is left is often insufficient to properly balance the day’s schedule between straightforward visits and complex cases. “I’ve seen firsthand that the world of geriatric medicine is a world of shrinking time,” says Neal K. Shah, CEO of CareYaya Health Technologies and cofounder of Counterforce Health. “It’s a world where the lifeline of the older adult population and their caregivers is measured in a few precious hours every week—time that should be spent not annoyed in front of a computer screen, but with the patients whose lives have been entrusted to the health care provider.” Physician respondents to a Medscape survey identified rules and regulations as their top time management challenge (21%).1 Dealing with government and commercial payers (13%) was in the top five. Another study found that physicians spent just 27% of their total time on direct clinical time with patients and more than 49% on EHR and desk work, with many reporting an additional one to two hours of “pajama time” documenting in the EHR after hours.2 Left unchecked, these time management issues can lead to higher burnout levels, sluggish revenue streams, and inadequate time to effectively care for a growing geriatric patient population. Increasingly, the solution lies in deploying AI and optimizing existing technology tools to address time management issues in the areas of patient triage, scheduling, clinical documentation, and payer requirements, including prior authorization (PA) and denial management—without impacting patient care. Finding Patient Time While EHRs and practice management software typically come with scheduling tools, they can be too rigid to accommodate geriatric medicine’s encounter needs. “Geriatricians understand that [senior] patients and their families need more time than the typical scheduling template is going to give them,” says Chris Vercammen, MD, a board-certified internal medicine physician and medical director of Remo Health, a virtual provider focused on dementia care. “If I can give someone a lot of time upfront, it cuts down on the amount of time on the back end in terms of phone calls and inbox messages about things that didn’t get answered or followed up on.” In addition to customizing scheduling templates, he recommends identifying processes and tools that help physicians optimize the time they have. For example, Remo Health sends patients and/or their caregivers detailed questionnaires to complete electronically prior to the visit, which a care navigator then integrates into the patient’s chart. This approach ensures that a detailed medical history is available to the physician before the appointment, allowing them to maximize the encounter. “The more we can have patients and families do outside of that blocked visit time, the more useful we can make that time and visit,” Vercammen says. Patient triage is key to effective scheduling. It differentiates between those who need more time and those whose needs can be met within a 15-minute encounter. Lindsay Dymowski, president of Centennial Pharmacy Services and cofounder and principal of The Centennial Group, points to increasingly popular predictive analytics to streamline and optimize triage activities. Built into most of today’s EHR systems, predictive analytics tools can help determine the appropriate visit length and “help providers manage complex and chronic diseases before they become extremely critical. … They can prompt preemptive actions so that providers can address issues like adjusting treatment plans or engaging patients with additional support before a hospitalization occurs,” says Dymowski, who previously worked in ambulatory care coordination to support complex and chronic cases for Medicare and dual-eligible patients. Similarly, Jessica Wagner, chief operating officer of RXNT, recommends that practices wanting to optimize scheduling look for tools that can streamline and improve the accuracy of patient triage. For example, tools that enable an intake workflow allowing the entry of both free text and standardized data can conduct holistic triage assessments using all available information, including free text clinical notes and internal messages. “Leveraging available tools to make sure that those appointments are the right duration helps doctors feel less pressed for time so they’re not scrambling to get everything done in 30 minutes and maybe not getting the patient the time they need,” Wagner says, adding that “not keeping patients waiting in the waiting room for longer than necessary is also important.” Clinical Documentation Roadblocks However, one-size-fits-all technology solutions can be hard to find. “Not only do no two doctors chart the same way, but no two doctors think the same way, and no two doctors practice the same way,” says Richard Low, MD, CEO of Praxis. “The purpose of an EMR is to empower the physician. It’s a medical tool to empower the physician to do his or her job easy, better, and faster.” He says the average provider wastes about three hours a day in front of the computer. With the right EHR and/or software tools, that time can be slashed to 15 minutes. The right technology can also “improve the quality of the documentation and, more importantly, improve the quality of medicine the doctor practices,” Low says. Vercammen notes that scribes and ambient listening technology are solid options. However, the associated costs can be beyond the reach of many geriatric medicine practices. Instead, he recommends looking at what is already available in the practice’s EMR or practice management system, such as prebuilt documentation templates that let physicians fill in the blanks and quickly move on. “Anyone working in a large system has been hit over the head with ‘here’s how to be more efficient on your charting.’ But hopefully, as we get better tools to capture what’s said in the visit and document it without having to do it ourselves, that will help a lot,” he says. “But realistically, documentation is always going to be a challenge everybody’s trying to figure out.” Wagner highlights AI-generated encounter summaries that provide a concise accounting of the patient’s previous visit so physicians can optimize their next encounter and inform care decisions. These tools can also identify discrepancies, for example, between medication dosages mentioned in a clinical note and the medication list. “It’s surfacing insights for the doctors and ensuring that if they were to get audited, their documentation is aligned,” Wagner says. Other tools to consider are AI notetakers to speed documentation and improve accuracy, and tools that use clinical notes to complete fee tickets or superbills and send them to the biller for review and release. “It really cuts down on the number of steps that a doctor would need to take to get a claim out the door,” Wagner says. “In the case of this population, probably a Medicare claim.” Byzantine Payer Requirements Vercammen recommends a technology-adjacent solution, changing workflows by assigning tasks to different clinical team members to complete outside the scheduled encounter. For example, having medical assistants conduct medication reconciliations via Zoom instead of during the visit. This kind of creative use of nonvisit time can pay off because it ensures compliance, and “you’re going to give a better quality of care because you’re getting more useful data and then devoting more of the appointment time to what it should be for,” he says. The most significant—and frustrating—payer-related time management burdens are PA on the front end and denial management on the back end. According to an American Medical Association survey, a practice completes, on average, 43 PAs per physician per week—a task physicians and their staff spend 12 hours completing each week. What’s more, 89% of physicians said PA somewhat or significantly increases physician burnout. They can also impact patient outcomes, with 94% of respondents saying PA delayed care and 93% indicating it had a somewhat or significant negative impact on care outcomes.3 “Obtaining insurance authorizations for geriatric patients is especially difficult,” Shah says. “These patients typically have complex cases that involve many different types of conditions, medications, and medical specialists. I find many geriatric medicine providers are spending over 25% of their time, on average 120-plus hours a week, dealing with insurance-related paperwork.” Some of that time goes toward managing denied claims, although about 65% of medical claim denials are never resubmitted due primarily to time and resource constraints.4 Just 45% of appeals overall and 41% of Medicaid appeals are successful. PA and denial management are “literally the easiest and simplest use case for AI,” Shah says, whose company offers a free AI tool for physicians and consumers that automates both processes. By letting AI deal with the monotonous documentation, clinicians and staff can focus on patient care and outcomes. According to Shah, one geriatric medicine practice he works with deployed AI for PA and denials and reduced its administrative time by 62%. Physicians were subsequently able to add four patients to the daily schedule—without forcing physicians to rush visits or impacting satisfaction or outcomes. Automating Time Management The most important step, however, is for physicians and staff to make some noise when things aren’t working, whether with manual or automated processes. — Elizabeth S. Goar is a freelance health writer based in Benton, Wisconsin.
References 2. Physicians spend two hours on EHRs and desk work for every hour of direct patient care. Physicians for a National Health Program website. https://pnhp.org/news/physicians-spend-two-hours-on-ehrs-and-desk-work-for-every-hour-of-direct-patient-care/. Published March 31, 2023. Accessed February 19, 2025. 3. American Medical Association. Prior authorization physician survey. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf. Published 2023. Accessed February 19, 2025. 4. Richardson N. Medical claim denial statistics & fact 2025. Advisement website. https://advisement.com/medical-claim-denial-statistics/. Updated February 3, 2025. Accessed February 19, 2025. |
