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Why are patients waiting longer for doctors? The culprit lies with government-mandated reporting.
I recently encountered a patient who complained about the waiting time. I politely apologized and we discussed some of the reasons for the often long wait for a physician’s appointment. We covered the usual culprits such as urgent phone calls or other emergencies, extended time required for an acute problem, or issues with starting the day on time. However, a problem that recently made its debut is ensuring the boxes in the EHR for meaningful use, the Physician Quality Reporting System (PQRS), and other insurance-based incentives have been checked. My patient had no idea that this tedious process was a prime contributor to her extended wait period.
I explained to her the incentives created from healthcare reform caused an explosion of EHRs in physicians’ offices, and introduced the mindless box clicking that the federal government now requires. This trivial task of recording meaningless data subtracts from time to care for the patient.
The federal government wants accountability. However, accountability in turn deserves an immediate and direct payoff. The ACA’s payoff is quality healthcare at the lowest price. Yet in my eyes, this seemingly menial box clicking of the EHR has never contributed to my patients’ care. It just makes the patient’s wait time longer.
In the near future, Medicare’s fee-based system will be replaced by bundled payments and quality measures, which are currently being developed by the medical societies in conjunction with CMS. The data dump that will be required to determine each individual physician’s reimbursement is unknown and will likely be overwhelming. The intention is to quantify the value of the service, in order to receive appropriate payment. Like all of the previous quality reporting efforts from the government, this may end up to just be more busy work.
Modern medicine has given us a lot of knowledge and fabulous tools to improve the health of each patient, but I can’t help worrying that some of these “tools” will just get in our way of providing the highest standard of care. Although change is a given for any profession, we must continue to maintain the tenets of medicine by providing quality care for all patients, and hope they don’t just have to wait longer.