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    ‘I can’t keep up’: Pay cuts, prior authorization take their toll

    State-level advocacy, effective communication crucial to addressing administrative burdens


    Administrative overload

    A common complaint we hear from practices across the country is: “I cannot keep up.” Many practices are increasing their staff, turnover in office staff has increased, and administrators who have been working in the same place for years are leaving. Some staff turnover is due to burnout; others are being forced out because they can no longer do what is asked of them. In addition, we have all seen a number of reports on physician burnout at record highs, especially in urology.

    Also see - Lifestyle creep: What is it, and how do you avoid it?

    Some of the big contributors to the increase in administrative burden include:

    • prior authorization and/or pre-certification of drugs and procedures
    • EHR use
    • medical record requests prior to payment
    • the Physician Quality Reporting System, meaningful use, and going forward, MIPS
    • increased patient collection requirements
    • Recovery Audit Contractor (RAC) audits and other take-back requests
    • increased specificity for billing.

    Income reduction

    In addition to the increased cost to administer a practice, most are also seeing a reduction in payment per service or, at the very least, a relative reduction in payment as payments are not rising with the costs associated with practicing medicine.

    Big contributors here include:

    • changes in bundling rules and patterns
    • expanding and exacting interpretation of what is included in a global
    • decreases in relative value units and associated fees for high-volume procedures
    • modifications to the interpretation of modifiers
    • coverage changes and restrictions.

    Next: State legislatures could help

    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.


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