Doctors Want Face Time With Patients, Not Screen Time With CMS
The health care industry has entered a brave new world in which doctors spend up to half the length of each appointment looking past their patients at their computer monitors. Despite these appearances, doctors do prefer to treat the patient in front of them, not stare at the computer screen next to them. So, what’s stopping them?
A common—I dare not say popular—answer is federal regulations set by the Centers for Medicare and Medicaid Services (CMS). Many doctors divert extraordinary resources away from patient care toward attempts to comply with CMS’ cumbersome “meaningful use” reporting requirements concerning electronic health records (EHR).
“We would much rather look into our patients’ eyes, talk with them, examine them, and understand not only what’s wrong and where it hurts but also what their hopes and dreams and fears and expectations are,” Dr. Mike Koriwchak told me during an episode of the Health Care News Podcast in May. “Unfortunately, the way federal regulations are structured, if we don’t stare at the computer screen, we will take a financial hit that could knock us right out of practice.”
Like many doctors, Koriwchak, vice president of the Docs4PatientCare Foundation and cohost of The Doctor’s Lounge Radio Show, was initially relieved to hear rumors CMS would sunset meaningful use as part of its implementation of the Medicare and CHIP Reauthorization Act (MACRA), which Congress passed in April.
Unfortunately, CMS’ new doctor rating system, the Merit-Based Incentive Payment System (MIPS), merely renames the agency’s EHR reporting requirements and combines them with other criteria used to determine whether doctors qualify for full reimbursements for the care they provide.
“Based on what I’m seeing so far of MACRA, I think we’re still going to be clicking a lot of boxes in 2017,” said Randy McCleese, vice president of information services and chief information officer at St. Claire Regional Medical Center in Morehead, Kentucky, to HealthLeaders Magazine in July. “The meaningful use program is just being rolled into and consumed into something bigger and something broader.”
If the next dispensation of EHR reporting requirements looks like the first one, doctors and patients may soon be making even less eye contact while in the exam room. Dr. Albert Johary says his patients at Emory Healthcare in Atlanta, Georgia have noticed the resulting erosion of bedside manner.
“The patients definitely sense that we’re a lot more stressed now,” Johary told the American Medical Association (AMA) for a Break the Red Tape event, Becker’s Healthcare reported in October 2015. “We’re spending three hours more per day—and that’s no exaggeration—just trying to get caught up. I do mine real-time, I do my charting when I’m in the room with the patient, but still that leaves no time to answer the phone calls, to answer the people that have called in, or sign off on the labs, etc. So I’m leaving at 7:30, 8 o’clock every single day. That’s not sustainable.”
Doctors who, unlike Johary, successfully wrangle federal EHR reporting requirements during normal business hours do so at a cost. A string of patient visits running longer than scheduled could drive up labor costs for an entire medical team, Dr. William Strinden of Memorial Hospital in Lufkin, Texas told AMA.
“Each hospital visit requires at a minimum 10 minutes longer than it did before,” Strinden said. “I see 30 patients each office day. If I wasted only three minutes per patient, that would add up to an extra hour and a half of work. I have [a registered nurse] and three employees who have been with me at least 12 years and do a good job and are well-compensated. It would cost me at least $100 per day extra just in lost time.”
Treating patients is a more meaningful use of everyone’s time and money than treating CMS to screen time at patients’ and doctors’ expense.
The federal government’s takeover of EHR has sapped the efficiency from electronic medical records. Barring corrective action by federal lawmakers or bureaucrats, CMS will continue to deprive patients of valuable face time with their doctors, undermining the agency’s own stated objective of “continuous quality improvement at the point of care.”