It is no mystery that today’s healthcare comes with mountains of paperwork. As a consumer we see the front and back slopes of these mountains, but rarely the summit. This piece of the equation falls on the providers and their administrative staff. Consider this: Where do you think all of those confusing details about your diagnosis, care, follow up, and ultimately your bill come from? Someone has to document everything about your care...start to finish. Just a piece of this process requires the physician to document their care, which is used for the medical coding to assign diagnosis and procedure codes for insurance reimbursement. This piece alone requires time and a high level of expertise. A recently published study in the Annals of Internal Medicine found that for every hour physicians were seeing patients, they were spending nearly two additional hours on paperwork. It is difficult for me to imagine a physician pursuing the medical field and truly recognizing this administrative burden before it is too late. Many physicians are trained once in the field for these pieces (if at all), including the sophisticated medical coding process. This barrier to care is enormous and it bleeds over into the patient experience. Have you ever needed care and then sat with a physician while they type into their laptop? They are documenting everything...what’s wrong and what they are going to do about it...and that is just a start.
The study confirmed what many physicians have already observed (such as James Sanders, MD in this 2005 editorial for Family Practice Management): the amount of paperwork that doctors have to do is out of control. Led by Christine Sinsky, MD, at the American Medical Association, the study followed 57 U.S. physicians in family medicine, internal medicine, cardiology and orthopedics for a total of 430 hours. In addition, 21 physicians completed after-hours diaries. The results? Physicians spent 27% of their time in their offices seeing patients and 49.2% of their time doing paperwork, which includes using the electronic health record (EHR) system. Even when the doctors were in the examination room with patients, they were spending only 52.9% of the time talking to or examining the patients and 37.0% on paperwork. The doctors who completed the after-hours diaries indicated that they were spending one to two hours each night doing...paperwork (or the EHR). I have seen it. I watched a friend last week sit at his son’s wrestling tournament with a laptop doing this work.
It is not getting better. Previous estimates such as from this 2005 study in Annals of Family Medicine were that paperwork consumed a third of physicians' time. So, in a decade of technological and medical advances, paperwork has gone from being a portion to a majority of a doctor's time.
The main factors for this load of paperwork are fairly easy to identify. First, there are now so many people involved in a doctor's practice beyond the doctor himself or herself. You've got people in administration, lawyers, insurance companies, etc., all asking for information, which produces more and more paperwork. This paperwork is less about providing care and tracking your health and more about getting paid for services rendered.
Secondly, doctors have little input in the design of much of the paperwork. Therefore, whoever is designing and requiring the paperwork is not focused on making the process easier on the doc.
The third problem is that many doctors are struggling to find assistance with the paperwork. Both hospitals and clinics are typically not focused on clerical and administrative support for doctors. So we have a difficult process and little help. There are partners in the marketplace that can help, including documentation improvement consulting, outsourced medical coding, compliance reviews, and practice management.
And finally, fourth, the system is not changing to accommodate the needs of doctors. How much investment is there in finding and implementing ways to improve clinic operations and the workflow and lives of physicians? Sure, there are companies that offer help in every possible area of the process - but the expense can be difficult to swallow for individual physicians, or the administrators of practices or facilities. It is a big process - which carries with it a high level of expense.
Ultimately the biggest impact is on the patients. When physicians do not have time to counsel with their patients the end result is a decline in the quality and outcomes of care.
To combat the issue, as a start, we need to focus on placing skilled personnel or services in these bottlenecks, adopt technology that simplifies and streamlines these processes, recognize that this is an issue impacting patient care, and accept that help is needed. Find the biggest offenders in your practice and put a plan in place to improve those areas. A couple of examples could be a better process for administrative staff to ask follow up and/or clarifying questions to the doctor, or just taking medical coding off of their plate by utilizing specialized staff or an outside partner. These types of small changes and improvements can drastically improve both the patient and physician’s levels of satisfaction.
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