Tri-organizational Workgroup Established to Inform the Design of Interventions to Reduce Burnout and Promote Professional Fulfillment Among U.S. Physiatrists
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.
In February 2023, our tri-organizational workgroup published the paper, “Occupational Characteristics Associated with Professional Fulfillment and Burnout Among U.S. Physiatrists,” which outlines characteristics of the work environment associated with professional fulfillment and burnout among U.S. physiatrists.
Most recently, we published a new paper in June 2024, "A qualitative study of strategies to improve occupational well-being in physical medicine and rehabilitation physicians," that builds on the previous paper's findings by investigating ways to address burnout in an independent cohort of physiatrists.
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.