- A recent study of physician EHR documentation activities under fee-for-service reimbursement shows that physicians spent less time with patients than anticipated by federal incentive payment programs.
Tai-Seale et al. analyzed EHR data and found that physicians spent half their clinical time on EHR documentation.
“Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day,” they wrote in Health Affairs. “Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients’ online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results.”
EHR use in hospitals and physician practices is touted by healthcare industry insiders as both a game-changing industry advancement and a detriment to the patient-provider relationship. And while many policymakers and healthcare experts view EHR technology as a means of supporting improve patient care and outcomes, EHR use may be dominating more of physicians’ time than previously thought.
Conducted over a three-year period between 2011 and 2014, Tai-Seale et al. used recorded data from more than 470 primary care physicians working on 765,129 EHRs. During this time, physicians logged over 31 million EHR transactions.
“The logs suggest that physicians allocate equal amounts of their clinically active time to desktop medicine work and to face-to-face ambulatory care visits,” researchers observed.
Given the significant amount of time doctors devote to daily EHR use, researchers posit the current policy shift from volume-based care to value-based care is a move in the right direction in terms of accurately reimbursing physicians for their services.
With so much emphasis on optimizing EHR use and implementing developing health IT infrastructure, federal incentives should be designed to avoid inadvertently punishing physicians for utilizing new technologies.
“Staffing and scheduling in the physician’s office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts,” stated researchers.
According to Tai-Seale et al., the Quality Payment Program under MACRA is properly designed to adapt federal incentives to the shifting technological healthcare landscape.
“Practices will have the flexibility to deliver care in the manner that best meets patients’ needs, without being tied to the office visit,” they claimed. “This is an explicit move away from payment for visits only, and an acknowledgment that critical aspects of patient care that happen outside the visit require appropriate compensation. Our research provides empirical data that support this change in physician payment policy.”
Additionally, research suggests less emphasis on fostering a personal patient-provider relationship may not be a negative development after all.
While some policymakers and physicians have voiced concern over the decline of face-to-face interactions between patients and providers, evidence shows a majority of patients don’t mind the less hands-on approach of an increasingly digitized healthcare environment.
“Consumers increasingly prefer services other than face-to-face visits: A recent survey of several thousand Americans found that 74 percent preferred ‘virtual’ encounters to face-to-face office visits,” noted researchers. “Our results showed that activities associated with virtual encounters included telephone encounters (9 percent), communicating with patients via the secure patient portal (3 percent), and refilling prescriptions (2 percent).”
A value-based care system would allow for physicians to comfortably prioritize these virtual encounters without fear of potential payment penalties.
“Compensation models should make delivering services in ways that meet patients’ preferences the easy thing to do,” concluded researchers.
With the transition year into MACRA and the Quality Payment Program underway, well-designed federal regulations could quell physician concerns regarding the new value-based payment system.