US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures

[eridani]

http://content.healthaffairs.org/content/35/3/401.abstract

On average, physicians and staff spent a total of 15.1 hours per physician per week dealing with quality measures, with the average physician spending 2.6 hours per week and other staff spending 12.5 hours.

By far the most time — 12.5 hours of physician and staff time per physician per week — was spent on “entering information into the medical record ONLY for the purpose of reporting for quality measures from external entities.”

The time spent by physicians and staff translates to an average cost to a practice of $40,069 per physician per year.

There is much to gain from quality measurement, but the current system is far from being efficient and contributes to negative physician attitudes toward quality measures. Improving the system rapidly will be difficult. Obstacles include the fragmented US health care system, lack of interoperability across EHRs, lack of EHR functionalities to facilitate retrieval of data for quality measures, the cost of change to external entities and to providers, and opposition from vested interests. Increasing efforts to reduce the number of measures and to standardize their use across external entities are being made by the National Quality Forum, the Institute of Medicine, and America’s Health Insurance Plans, as well as by federal agencies such as the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality. Our data suggest that US health care leaders should make these efforts a priority

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Comment by Don McCanne of PNHP: Quality measures in health care have proven to be burdensome, consuming excess resources in both time and money. This study quantifies those costs.

Not only do these quality games waste resources, they have become a significant contributor to physician burnout.

Wouldn’t it be far better to devote these extra resources to improving access to actual health care for the uninsured and underinsured who are now being all too often left out? It would be automatic under a single payer Medicare for all program.

[Orrex]

1. Hmm...

How many staff work in a typical doctor's office? I'm sure that the number varies, but let's assume 4 as a conservative average, plus one doctor.

So 12.5 hours per week divided by four staff equals 3.125 hours per person per 5-day week, or 37.5 minutes per day. When I worked the grill at Hardee's I spent more time than that on daily quality control.

Wouldn’t it be far better to devote these extra resources to improving access to actual health care for the uninsured and underinsured who are now being all too often left out?

Those are two separate question, and I'm not sure that these are "extra resources" in any case.

It would be automatic under a single payer Medicare for all program.

Would Medicare-for-all eliminate the need for quality measures?

[RobinA]

2. Medicare

is a huge part of the problem. I am not medical staff, but I work in a hospital in direct contact with patients. My job is clinical, not administrative. I spend a good bit of my time meeting time-consuming paperwork requirements that benefit the patient or the process of caring for the patient not at all. Which doesn't take into consideration the staff members who do nothing BUT shuffle paper to satisfy Medicare. If we took all the man hours spent meeting paperwork requirements and making sure we are meeting paperwork requirements, and put it towards actually caring for patients, we might actually have something.

[Orrex]

4. I get that...

but everybody says that about all paperwork. Even if Medicare is 100% of the problem, 37.5 minutes be day doesn't strike me as hugely burdensome.

What's a viable alternative? What's an acceptable amount of paperwork?

[RobinA]

5. An Acceptable Amount

of paperwork is the amount of time it takes to do the paperwork that is relevant to good patient care. I spend a good bit of time writing boilerplate so Medicare can check a box that I wrote something the way they want. What I could document in a sentence takes a paragraph. Some of it is utterly meaningless except to meet a requirement. Some things must be documented in several places instead of just one. I am jaded at this point. I will spend more time documenting what I did than actually doing stuff if that's what is required, I don't even blink anymore. When people ask me about my field I tell them to avoid it if they have any notion of doing good work.

[Orrex]

7. How much time do you spend relative to the cited 37 minute daily average?

Boilerplate is indeed bullshit, but just about every job I've ever had has involved more paperwork than actual work. Is the medical field unique in this regard?

[RobinA]

9. I Don't Know

if it's unique, it's just that the stakes are higher. I've worked for business and been a paralegal. Yeah, they were paperwork central, but who gives a crap? Virtually nothing of real value was at stake. In health care you are dealing with people's lives and well-being. When I'm spending the afternoon shuffling paper, I'm not talking to several clients. Multiply it by the better part of three days a week, times 50 weeks a year and you're talking a lot of interaction squandered.

[Orrex]

10. Your experience seems to have been worse than what the article describes

I've known nurses who worked for doctors who refuse to use a pen, or who never write anything down, or who refuse to use the designated codes and instead require their scribes to sort it out. My sense is that a great deal of the resistance to these changes originates with the doctors rather than their staffs.

Frankly, if it's costing an office $40K annually due to lost productivity, then that simply means they have $40K to pay an additional employee specifically to take care of that paperwork. This way the clinical personnel are freed up to tend to patients. Many offices have done something like this for years already.

An office manager (or equivalent) is tasked with administrative functions that would otherwise be dumped on the clinical staff.

If you're "spending the afternoon shuffling paper," then I infer that you aren't sitting with a patient during that time, so an appropriately trained clerical worker should be able to handle it.

Your time would be better spent, the patients would be better served, and another person would have a job. It's a win-win-win situation all around.

[Hortensis]

3. Americans spend about $7 billion on Halloween alone.

That's not to say I absolutely trust the figures in this article to not be chosen to further its theme, but only to help put these expenses in some kind of perspective.

"A billion here, a billion there, pretty soon you're talking real money." (Apparently a misquote of Everett Dirksen: ""Oh, I never said that. A newspaper fella misquoted me once, and I thought it sounded so good that I never bothered to deny it.&quot

Eridani, I recommend you go read all medical records you have access to for yourself and family. Our personal medical records are typically astonishingly, inexcusably, shockingly, even criminal-negligently incomplete and inaccurate.

Obamacare is also outrageously requiring they actually be made available to other medical professionals by requiring they move from paper to on-line electronic records. Unshared records of course result in mistreatment based on guesses and of course unnecessary-yet-necessary duplicate diagnostic studies at frequently hideous cost to the patients.

Obamacare is setting new, high standards for an industry whose customers desperately need them and is insisting this, and much more that has been hurting medical care for decades, be fixed -- at least as far as those clinicians and facilities that expect full reimbursement under Medicare are concerned.

And all of it would also be necessary if payment was handled as single payer.

[RobinA]

6. Medical Records

"Eridani, I recommend you go read all medical records you have access to for yourself and family. Our personal medical records are typically astonishingly, inexcusably, shockingly, even criminal-negligently incomplete and inaccurate."

This is the absolute truth. I have occasion to read medical records of my patients from way back. What a tragic difference.

The problem is that people, due to staffing and volume of work, don't have the time to do those complete histories anymore. The other problem is that paper is completed according to instructions and to answer specific questions only. A history is now a form rather than a narrative. On a history now you fill in blanks and check boxes, and you have a limited time to do it. This is an example of paperwork that could be useful in treating the patient getting buried by the nonsense paperwork being done to fulfill requirements that many times don't even apply. What a damn mess.

[Hortensis]

8. Yes, but it should get better. A major part of the problem

is that lot of practices purchased early and/or cheap EMR systems that don't work well.

But a whole lot of it is just plain sloppy record-keeping by physicians themselves. Many have always been negligent and don't want to change. Of course there's a lot of resentful fussing -- by some -- over having to clean up their act, bless their sloppy little hearts.

This shabby attitude is built in deep. When my husband had 2 hospital visits 6 weeks apart, I was genuinely shocked to discover that the local medical center had NO medical information on him at the second visit. Not even his blood type. Turned out they kept billing info indefinitely but medical info on their patients -- all their patients, no matter how frequent -- only 6 weeks. Obamacare's changing that too.

I remember reading that aseptic techniques developed in the 19th century took decades to become standard practice because many physicians refused to accept that they could be killing their patients and kept right on doing it. But in the end, they learned to mostly wash their hands and change their gloves when they were supposed to.