July 6th, 2011 by BobDoherty in Health Policy
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For physicians, and especially those in primary care, it seems like there is a form for every purpose imaginable—often for purposes that are hard to imagine.
An ACP member in Rhode Island recently gave this example:
“I was just asked by my Medicare Advantage plan to sign a form for [a well-known pharmacy benefit manager]. This form is to be faxed to them in order for them to send me a prior authorization form for a med. So in other words, I had to complete a form in order to get another form. This is nuts!”
Or how about this, from another ACP member in a private internal medicine practice:
“The documentation that is getting to me, is that documentation that the ‘durable medical equipment people want including repetitive- recurrent documentation, whenever we see a patient to document “continued need”. The list of things we have to document, sign, approve or prior authorize, I believe is what makes most physicians think they chose the wrong field. A PBM letter to me about my prescribing practices today nearly did me in! Luckily I just shredded it. If I am kicked out of this business, I am so close to retirement it would be a blessing!”
Or this: Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
February 17th, 2010 by DrRob in Better Health Network, Health Policy, Opinion
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I am going to state something that is completely obvious to most primary care physicians: I do not accept Medicare and Medicaid patients because it is good business, I accept them despite the fact that it is bad business.
In truth, I could make that statement about insurance as a whole; my life would be easier and my income would be less precarious if I did not accept any insurance. If I did, I would charge a standard amount per visit based on time spent and require payment at the time of that visit. This is totally obvious to me, and I suspect to most primary care physicians. A huge part of our overhead comes from the fact that we are dealing with insurance. A huge part of our headache and hassle comes from the fact that we are dealing with insurance. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
January 21st, 2010 by KevinMD in Better Health Network, Health Policy, Opinion
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It’s no secret that without a stronger primary care foundation, the current reform efforts are unlikely to be successful. If anything, it will only delay the inevitable.
I wrote last month that one discussed solution, adding more residency slots, won’t help: it would simply perpetuate the disproportionate specialist:primary care ratio.
A recent op-ed in The New York Times expands on that theme. The authors suggest that not only does primary care need to be promoted, specialist slots should be limited. Simply building more medical schools, or adding more residency slots, without such restrictions will only add to the number of specialists.
Already, many primary care residency slots go unfilled – what’s the point of adding more?
You have to solve the root cause that shifts more students away from primary care: disproportionately low pay, disrespect that starts early in medical training, and poor working conditions where bureaucracy interferes with the doctor-patient relationship.
Until each of those issues are addressed, simply more spending money to produce more doctors simply isn’t going to work.
*This blog post was originally published at KevinMD.com*
September 29th, 2009 by Dr. Val Jones in Health Policy, Opinion
7 Comments »
Ever wonder why your physician only spends 5-10 rushed minutes with you during your office visit? You may think it’s because there are simply too many patients vying for her time, but that’s not the real reason. The root cause is that health insurance companies are stealing time from your visit by requiring excessive documentation from your doctor. She can’t give you the time you need, because doing so would put her out of business.
In a special report on the administrative burden of healthcare, MedPage Today revealed that PCPs spend about one third of their income on documentation required by health insurers. Because they run a business with thin margins, they must increase the volume of patients they treat in order to cover the salaries of the staff required to manage this “paper weight.”
About 49% of all physicians have said that they are considering retiring or quitting medicine in the next two years (the rate is lower for specialists), largely because of increasing documentation requirements and decreasing reimbursement. Read more »
June 26th, 2009 by DrWes in Better Health Network
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I filter through progress notes looking for the few sentences different from the day before, only to find them sandwiching pages and pages of electronically-produced babble dutifully and automatically mass-reproduced in every note. I wonder, has anyone ever looked retrospectively at the mess created by this process developed to assure doctors were doing what they said they were doing? Ironically, I find we’re rarely reading most of what we re-create each day.
But we’re sure good at following the rules.
Next.
I now see prescription refills for each and every bottle of prescriptions ever filled by a patient, the date a patient filled it, and how many pills they received with each prescription. I’m not sure why. I sat awestruck in clinic yesterday when the list extended 94 pages, double-spaced, since January, 2009. No one, and I mean no one, filled that many prescriptions, did they? Or did they? Am I supposed to correct that list? Oh, by the way dear referring doctor, my note’s at the bottom of that listing.
Next.
I get pre-surgical notifications, even though I was the one to notify everyone else about the need for admission, just so I can click on the patient’s name again, lest it not appear I’m not doing enough, I guess.
Next.
I get EKG results forwarded for me to sign electronically, even though I’ve already read them, and signed them, by hand, on the EKG. I get notified again that the order I entered for that EKG now has a result, and I have to click on that to tell the computer, “I know.” But that, you see, is not enough. I must also log in, review, and sign off on my EKG’s on the EKG server, too. After all, I’m responsible, and it’s all about quality.
Quality three times over.
Now, multiply that same process for each and every other test I have ordered.
Next.
I see orders for things I’m not sure I ordered, just to be sure I’m responsible, and watching, literally hundreds of times per day.
Next.
I get e-mails and electronic notifications, and electronic communications, as if I know the difference.
Next.
I bypass nursing notes that are mere QA checklists and say nothing about the patient, except that a nurse was there last night.
Next.
I feel guilty entering data as I talk to my patient while serving my electronic master. Yet I find the stakes are high to assure accuracy and timeliness in clinical electronic reporting. After all, you never hear the bullet that hits you.
Next.
I go home on call, am paged, and reprimanded by a patient who wonders why I can’t look up their medication list on-line, even though I’m standing in the grocery store.
Next.
Worst of all, I find myself sending myself messages, just to make sure I do something tomorrow that I could not get done today.
Killing me softly …
… with information overload.
*This blog post was originally published at Dr. Wes*
