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Clicking for "Quality" Care is Frustrating


One doctor shares her problems with insurance companies making time-consuming, non-reimbursed checklist requests of physicians.

When did we lose control and perspective? Our primary-care clinics recently received reams of paper from an insurance company requesting that our physicians log on to their proprietary EHR to update items such as when we last assessed the physical activity level, gave a flu shot, counseled on diet, and many other preventive health measures for thousands of individual patients. There is no compensation or reimbursement for this activity, which can take physicians hours upon hours to do. Instead, there is an expectation that already under-reimbursed physicians who spend too much time on the computer documenting all kinds of clinically meaningless items and performing sometimes hours of work each day in non-reimbursed care will add additional time to their day to satisfy the demands of an insurance company.

What amazes me about this request is that someone, somewhere believes that physicians and health systems will do this. We have become used to doing extra work without reimbursement, electronically documenting many things which never would've made it into a paper-chart, and acquiescing to increasingly time-consuming demands to satisfy a government regulation, insurer's request, or even our patients' lawyers. Therefore, it is no longer shocking that an external organization asks us to jump through more hoops without any appreciable benefit to the patient.

This has led to checklist-compliant, clinically meaningless medicine. For Medicare's benefit, I need to counsel my patient on diet and exercise if they are overweight and this information needs to be documented in a way that is readily retrievable so we can report it to numerous external entities. It does not matter if the counseling has no clinical relevance for this particular patient. It does not matter if I do a good job or connect with my patient. It's probably important that I use a lot of flowery language to talk around the fact that the patient is obese because they may be offended by the term "obese" and rate me poorly on CG CAPHS survey, which will lower my reimbursement.

I believe good physicians will take the "hit" to do the right thing for patients even if their so-called quality scores or patient satisfaction scores suffer. So, I am less concerned about the integrity of my colleagues, who consider medicine a calling, not a business, and those we serve patients, not customers. Instead, I am concerned that we've equated quality care with so many metrics that can be satisfied by a mouse click or check box. This mindset has led to an overwhelming number of required "clicks" in many EHRs and a feeling of frustration by providers who are being instructed, in a sense, about how to best take care of a complex human being in a way that makes it easy to collect data and audit performance at a superficial level.

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