What Sports Medicine Reveals About Administrative Burden in Healthcare

The administrative burden in healthcare doesn’t clock out when clinic ends. For a sports medicine physician, it follows them to the sideline on Friday night, into the training room on Saturday, and back to the laptop on Sunday, when the notes from every evaluation still need to be written.

On EP 04 of Truly Integrated, Dr. Joshua Brandon, a primary care sports medicine physician at Campbell Clinic Orthopaedics in Memphis, sat down with iScribe CEO Pat Williams. His practice spans non-operative orthopedics, ultrasound-guided injections, orthobiologics, fracture management, and concussion care, and he serves as a team physician for professional and collegiate sports in Memphis. Few specialties show the paperwork problem more clearly.

Prefer to listen? Hear Dr. Brandon’s full conversation on Truly Integrated, EP 04: episode page · Apple Podcasts · Spotify

Key Takeaways

• Primary care sports medicine carries a heavy, often invisible documentation load across clinic visits, procedures, and sideline care.
• Sideline evaluations create unique documentation challenges, with notes often completed after games under time pressure.
• Orthobiologic treatments like PRP still face reimbursement barriers because many payers classify them as experimental, driving denials and rework.
• Concussion care requires thorough, longitudinal documentation to support diagnosis, treatment, and safe return-to-play decisions.
• AI-powered documentation cuts the administrative burden, but the physician’s independent clinical judgment stays in charge.

Where the Administrative Burden Really Comes From

The administrative burden in healthcare is usually discussed as a single number, hours per week spent in the EHR. Dr. Brandon’s day shows why that number undersells the problem.

That number is big on its own. In a 2016 time-and-motion study of 57 physicians in four specialties, including orthopedics, published in Annals of Internal Medicine, physicians spent 27.0% of their office day on direct clinical face time with patients and 49.2% on EHR and desk work, and the 21 physicians who kept after-hours diaries reported another 1 to 2 hours of work each night, mostly in the EHR. But hours alone don’t capture what makes a sports medicine day hard.

His day might run from a fracture follow-up to an ultrasound-guided injection, then a new concussion evaluation, a PRP consult, and a team physical. Each encounter carries different documentation requirements, different coding considerations, and different payer expectations. The burden comes from variability as much as volume.

Then there’s sideline care. When a physician evaluates an athlete during a game, there’s no exam room, no workstation, and no time. The documentation happens later, from memory, after the event is over. That’s where detail gets lost and where after-hours work piles up.

The Main Drivers of Administrative Burden in Healthcare

Dr. Brandon’s week touches nearly every source of administrative work a practice deals with. Here is where it comes from, and where complete documentation makes a difference.

• Clinical documentation → In a sports medicine practice: Clinic visits, procedures, and sideline evaluations → Where complete notes help: Notes finished at the point of care, not from memory.
• Coding → In a sports medicine practice: Different coding considerations for injections, fractures, and concussion visits → Where complete notes help: Codes backed by what the note records.
• Payer rules and denials → In a sports medicine practice: Orthobiologics like PRP often classified as experimental → Where complete notes help: Medical necessity documented clearly, with less rework.
• Prior authorization → In a sports medicine practice: Approvals needed before certain treatments → Where complete notes help: Supporting details ready when requested.

Payer Variability Turns Paperwork Into Revenue Risk

Dr. Brandon spoke directly about payer variability and denials, and orthobiologics are the clearest example. Treatments like PRP continue to face reimbursement barriers because many payers still classify them as experimental. The result is a cycle of denials, appeals, and administrative work that pulls staff and physicians away from care.

The problem sits in the system. Rules differ from plan to plan and change frequently, and the physician is expected to document perfectly against all of them, in real time, while seeing a full schedule.

The data backs this up. Among ACA Marketplace plans on HealthCare.gov, insurers denied 20% of in-network claims in 2023, and individual insurers’ denial rates ranged from 1% to 54%, according to a KFF analysis of federal data. After the catch-all “other” category, administrative reasons were the most common reason insurers cited, at 21%.

This is why the administrative burden in healthcare is a financial problem as much as a time problem. Incomplete or imprecise documentation is the root of documentation-related denials, and every denial creates more paperwork.

Concussion Care Shows Why Documentation Quality Matters

Concussion management is one of the most documentation-intensive areas Dr. Brandon covers. It requires thorough, longitudinal records that support education, diagnosis, treatment planning, and return-to-play decisions over multiple visits.

In that setting, the note is a patient safety record. A vague note today makes next week’s return-to-play decision harder and less defensible. A precise note gives every provider on the care team the full picture.

Documentation technology has to meet that standard and be complete enough to protect the patient, the physician, and the claim.

How Administrative Burden Reaches the Patient

Paperwork can look like a back-office problem. It lands on patients too.

Less time in the room. In the same Annals study, physicians spent 52.9% of their exam-room time on direct clinical face time and 37.0% on EHR and desk work.

Denials that rarely get challenged. In HealthCare.gov plans, consumers appealed fewer than 1% of denied in-network claims in 2023, and insurers upheld 56% of the denials that were appealed, KFF found.

Burnout. Physician burnout affects more than 50% of U.S. doctors and has been linked to time spent in the EHR, particularly after hours, Mass General Brigham notes. For more, see our look at AI and physician burnout.

That is why we treat documentation as part of patient care, not a separate chore.

How AI-Powered Documentation Reduces the Burden

Dr. Brandon shared how iScribe has reduced the time he spends documenting after clinic visits, sideline evaluations, and procedures. Instead of manually drafting notes, he spends that time engaging with patients and athletes.

That shift is measurable. iScribe providers save roughly two to four hours per day and see 10+ more patients each week. Notes are processed in about 30 seconds, so the documentation is done before the next encounter starts. Sunday night stays free.

Independent research points the same way. In a Mass General Brigham-led study published in JAMA Network Open, drawing on surveys of more than 1,400 physicians and advanced practice providers, use of ambient documentation was associated with a 21.2% absolute reduction in burnout prevalence at 84 days at Mass General Brigham, the health system reported. The authors note the respondents were pilot users and call for more research.

In our view, these capabilities make the difference for a varied, high-volume practice.

Provider-specific macros. A sports medicine physician’s injection note, fracture follow-up, and concussion evaluation each follow their own structure. iScribe macros are tuned to each provider’s preferences and requirements.

Deep EHR integration. Notes land directly in the chart, whether the practice runs on athenahealth, NextGen, Epic, or another integrated EHR.

Coding intelligence. iScribe Code Intelligence delivers E&M code recommendations with 95% audited accuracy, grounded in AMA MDM guidelines, for orthopedic and urology practices on athenahealth or NextGen.

Real-Time Guidance Before the Claim Goes Out

Dr. Brandon also looked ahead to real-time AI guidance that catches missing details in documentation before a claim is submitted. He also pointed to the value of broader intelligence-sharing networks that would bring more transparency to what payers approve and deny.

That’s the direction iScribe is building toward. Its mission is to end documentation-related denials, which we see as a fundamental flaw of modern medicine. Real-time denial prevention is already in development.

Just as important, Dr. Brandon was clear that AI strengthens clinical workflows without replacing judgment. The physician decides. The technology documents, organizes, and flags.

Let Physicians Take Care of Patients

Dr. Brandon’s closing words cut to the heart of the administrative burden in healthcare.

“Just let us take care of the patient. That’s what we care about. That’s what we’re trying to do. That’s what our oath is for. And the more that we’re able to focus on that, I think it’s just better for the patient, better for the medical community, and really better for our country.”

We agree with him. If you think the paperwork problem looks different in your specialty, tell us where.

Frequently Asked Questions

What is administrative burden in healthcare?

Administrative burden in healthcare refers to the documentation, coding, prior authorization, billing, and compliance work physicians and staff complete outside of direct patient care. It’s a leading driver of after-hours work, burnout, and documentation-related denials.

How does AI reduce administrative burden for physicians?

Ambient AI captures the patient encounter and produces a structured clinical note in real time. iScribe providers save roughly two to four hours per day, with notes processed in about 30 seconds.

Why are orthobiologic treatments like PRP often denied?

Many payers still classify orthobiologics as experimental, which creates reimbursement barriers. Precise, complete documentation is essential to support medical necessity and reduce rework.

What are the main drivers of administrative burden in healthcare?

Clinical documentation, coding, payer rules and claim denials, prior authorization, and compliance work. In sports medicine, the mix of clinic visits, procedures, and sideline evaluations adds to each one.

Why is sideline care hard to document?

Evaluations happen during play, away from any workstation, so most get written up after the game, sometimes hours later. Documenting each sideline encounter as part of the same workflow as clinic visits keeps those notes complete and consistent.

How does administrative burden affect patient care?

It pulls physicians’ attention away from the visit, adds after-hours work linked to burnout, and creates denials and appeals that take staff and physicians away from care.

Does AI documentation replace the physician’s judgment?

No. iScribe drafts a signature-ready note for the physician to review and sign, and the physician makes every clinical decision.

About Dr. Joshua Brandon

Dr. Joshua R. Brandon, MD, CAQSM, is a primary care sports medicine physician at Campbell Clinic Orthopaedics in Germantown, Tennessee. He is board-certified in family medicine and sports medicine and specializes in non-operative orthopedics, with a focus on orthobiologics, ultrasound-guided procedures, and sports concussion. He earned his M.D. at the University of Minnesota Medical School, completed his family medicine residency at Halifax Health, and completed a primary care sports medicine fellowship at Wake Forest School of Medicine. He is fellowship faculty for the Campbell Clinic-UTHSC Primary Care Sports Medicine Fellowship, and his sports coverage includes the Memphis Redbirds and University of Memphis football.

Hear the Full Conversation

Listen to Dr. Joshua Brandon on Truly Integrated, EP 04, “Helping Physicians Focus on Patients, Not Paperwork.”

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