Wednesday, November 6, 2013

Doctors Drowning In Paperwork
The man whose life is devoted to paperwork has lost the initiative.  He is dealing with things that are brought to his notice, having ceased to notice anything for himself. He has been essentially defeated by his job.
C. Northcote Parkinson (1909-1993),  creator of Parkinson’s Law, “Work expands so as to fill the time available for its completion.”
In a remarkable series of recent articles in Forbes, Louis Goodman and Timothy Norbeck,  Chairman and CEO respectively of the Physicians Foundation,  have described the plight of physicians under ObamaCare (see
These Forbes  articles include,  “Why Healthcare Costs So Much,” “Promise (And Reality) of Healthcare,” “Obamacare Navigators Will Get $58 for Each Individual They Sign,” “Your Doctor is Likely Unhappy, Do You Know Why?”  and just yesterday,  “Healthcare is Turning into an Industry Focused on Compliance and Regulations Rather Than Patient Care.”
And alternative title for the last article might have been “It Isn’t the Doctoring, It’s the Documentation That Counts.”  Doctors already spend 22% of their time on paperwork rather than on patient care.  And with the push for electronic health records in every doctor’s office, that percentage is likely to go up.  
Adopting a medical record  reduces physician productivity by 30% in the implementation period.    In the words of Goodman and Norbeck, “Many like aspects of EHR but consider the usability, interoperability and functionality of the systems huge barriers. The confusing array of record systems, combined with a mob of over-anxious technology consultants is nothing short of a 21st Century ‘gold rush’ for patient data.’
Or consider imminent explosion of codes physicians and their staff must master before billing a patient.    Here is Goodman’s and Norbeck’s take on what that explosion will entail.

” For example, the way doctors record a patient’s medical problem or disease is going to drastically change next year…The International Classification of Diseases version 10 (ICD-10) contains 141,060 code sets used to report medical diagnoses and inpatient procedures. That’s a 712 percent increase over the 19,817 code sets in the currently used ICD-9 version. With the stop and go implementation of the ACA and an unending deluge of administrative changes in Medicare payment, 141,000 new codes could not come at a worse time for our doctors. As we have noted before, physicians are already spending 22 percent of their time.”

I could go on. Instead, I shall  close with this verse:
Where are doctors going to find more time for patients,
For whom they struggle to form  more lasting relations.
When they are tethered to the electronic health record,
Which the government and CMS say cannot be ignored?
And what about those 141,000  new ICD-10 codes?
The codes will add more to doctor paperwork loads.
Increased time spend on this thing called compliance,
Means less time expended on the doctor-patient alliance.

Tweet:  More time spent on electronic and coding busywork means less time devoted to patients.

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