Editor’s Note: This article is part of a Medical News exclusive series, “Who’s Tending Our Doctors?” to focus on ways the industry can help alleviate physician stress and allow physicians to return to the joy of practicing medicine.
Consider a patient on multiple medications who might generate several phone calls throughout the year as each medication comes due for renewal. Multiply it by hundreds of patients with chronic illness seen by a typical primary care physician, and it could quickly add up to thousands of phone calls every year. At two or three minutes per call, demands on the staff to manage prescription renewals could easily add up to an hour daily of unnecessary work.
An easy solution: a streamlined approach to prescription management. Instructions on how to effectively manage the practice change are available online free via www.STEPSforward.org through the American Medical Association (AMA).
“Streamlining prescription management allowed me to go home earlier,” said Christine A. Sinsky, MD, FACP, an internist with Medical Associates Clinic, a multispecialty group practice with sites in Iowa, Wisconsin and Illinois, and the AMA point person for STEPS Forward, its ambitious new initiative offering physicians strategies to revitalize their medical practices and improve patient care. “It’s made a huge difference not only with my personal time, but it’s also meant less inconvenience to patients and more personal time for them to do things other than worry about getting prescriptions refilled.”
In a study published in 2012 by Sinsky and Thomas A. Sinsky, MD, “A Streamlined Approach to Prescription Management” in Family Practice Management, the top priority is to eliminate waste.
“The work of prescription renewal has become so ingrained in practice that many physicians no longer recognize it as waste,” said Sinsky. “In fact, physicians commonly renew scripts for an arbitrary number of refills, thus guaranteeing unnecessary work for themselves and their staff a few months later.”
Physicians often use prescriptions as a prompt for patients to schedule subsequent appointments, a practice that burdens itself with unnecessary phone calls for prescription renewals and appointment scheduling, while also increasing the chances of patient non-adherence.
“A less organized approach to prescription renewal may have worked 20 years ago, when patients had fewer chronic conditions and took fewer medications,” said Sinsky. “Now, more than 40 percent of patients over age 65 are on five or more medications.”
Synchronizing prescriptions around the annual visit – providing sufficient refills to last until that time, and insuring the next annual visit is scheduled at the conclusion of the current annual visit – will take care of all those problems, said Sinsky.
“In our experience, it’s not uncommon for a group of six to eight primary care physicians to hire one full-time nurse whose main responsibility is prescription renewals,” she said. “This nursing time could be wisely deployed for advanced medical home activities, such as direct patient care, self-management support, or population management.”
A rough, conservative calculation suggests that if all practices implemented yearly, synchronized, bundled renewals, more than 46 million hours of primary care physician and staff time could be saved every year, noted Sinsky.
Most states limit prescription renewals to 12 months. A few states have a longer time period, such as a 15-month window, which further streamlines prescription management.
Policy makers could facilitate the elimination of waste by modifying state regulations to allow prescription renewals for an interval longer than 365 days.
“Several states already provide this important expanded window for renewals: Idaho and Maine (15 months), Iowa (18 months), and Oregon and California (two years),” Sinsky pointed out. “This allows patients and their physicians to balance insurance coverage rules – mammograms can’t be obtained more than once every 365 days, for example – and patients’ personal schedules with prescription renewal constraints.”
In summary, simple prescription renewal workflow changes in primary care practices, accompanied by modification of some state pharmacy regulations, would go a long way toward eliminating a source of significant waste in the U.S. healthcare system, improving the work life of nurses and physicians, and increasing access to primary care services, said Sinsky.
A rough, conservative calculation suggests that if all practices implemented yearly, synchronized, bundled renewals, more than 46 million hours of primary care physician and staff time could be saved every year in the United States.
LINKS:
AMA: http://www.ama-assn.org/ama
AMA STEPS Forward: https://www.stepsforward.org/