DEAR DOCTOR, TELL ME WHAT YOU REALLY THINK
Every two years one of the most interesting perspectives on medicine in America is published by the Physicians Foundation. www.physiciansfoundation.org/…/Biennial_Physician_Survey_2016.pdf
In the 2016 survey, 17,236 physicians responded to a wide variety of questions about their practice, the state of the healthcare industry, and perspectives on specific topics, including ICD-10. Although ICD-10 was still relatively new in 2016, the responses raise a red flag. Not that ICD-10 is a problem in and of itself, but that it is one more issue physicians have identified as problematic in the big picture. For some issues, the same or similar findings have now been published for six years, with some minor fluctuations, but appear to have fallen on deaf ears. These very same issues have been raised by numerous other industry stakeholders. These issues are the ones that scream administrative simplification is an oxymoron, that many EHRs are a barrier to quality care and the physician patient relationship, that far too much time is spent on red tape and non-clinical work, that the administrative burdens are overwhelming, that morale is low for many, and that both the patients and physicians have been lost in quest for “quality”.
While each of the issues could be addressed individually, I believe we need to start with the big picture. ICD-10 is just one small piece of the quality picture. There are the mandates enacted through the Affordable Care Act (ACA), the Medicare Access and CHIPS Reauthorization Act (MACRA), the Merit Based Incentive Payment System (MIPS), the electronic health records (EHR) incentive program, etc. When you add all of the other regulatory and clinical practice requirements physicians must meet, it is quite easy to see how quickly one can be completely overwhelmed. Unfortunately, each of these regulations seems to increase exponentially in complexity and difficulty. The rush to implementation has taken precedence over getting it right.
One thing EHRs were supposed to do was to greatly improve clinical documentation accuracy and thoroughness. As a result, diagnostic coding would be more specific, more accurate and better communicate patient care and outcomes. This would not only result in higher quality care but also in better data for analysis and more appropriate reimbursement. However, the physician survey results found only 29% of physicians believe EHRs improved quality of care, 25% believe it increased efficiency, and a disheartening 11% believe patient interaction was improved. 60% of responding physicians reported EHR has detracted from patient interaction.
Specific to ICD-10, the survey results also reflect a failure to meet the well intentioned goals. Only 6% of physicians see improved efficiency, 6% saw any increased revenue and even more disappointing, only 5% believe patient care has improved. Although 52% of responses said they saw no impact from ICD-10 implementation, 42.5% said it detracted from their efficiency.
It seems plausible that quality has gotten lost in regulatory requirements that impose additional time and non-clinical work burdens. Based on the survey, 21% of a physician’s time is spent on non-clinical work such as pre-authorizations necessary to meet payor reimbursement demands. Aggregated, that lost clinical time is estimated to be equal to 168,000 physicians! It also seems plausible that when physicians consistently report they are over extended, the time they do have is prioritized on their patient interactions and care, not becoming experts in all the regulatory demands and “quality” expectations. If EHRs are not efficient, clinical documentation improvement will fall victim to those inefficiencies. If clinical documentation improvement does not occur, the ICD-10 goals will also not meet the expected results.
Quality care, in the opinion of many physicians, has a much better chance of being realized when how, what, when and why are not based on regulatory and idiosyncratic payor requirements. Will every physician agree with the findings? Of course not. But there is a strong message from more than 17,000 physicians that we should heed.
“The happiness of too many days is often destroyed by trying to accomplish too much in one day. We would do well to follow a common rule for our daily lives – DO LESS, AND DO IT BETTER.” Dale E. Turner
Holly Louie, RN, CHBME, is the compliance officer for Practice Management Inc. and the 2016 HBMA president.