Providers are managing a balancing act where they try to deliver optimal care to patients while fulfilling a wealth of reporting requirements. An Annals of Internal Medicine study found physicians only spend 27 percent of their time on direct clinical face time with patients. The minimal time physicians have to spend with patients may detract from the provider-patient relationship and plays a factor in burnout amongst the medical community.
"Physicians feel that in order to help as many people as we can, we have to examine them very quickly," says John Finkenberg, MD, a spine surgeon at Alvarado Orthopedic Medical Group in San Diego and North American Spine Society's advocacy council director. "A patient's appointment must be shared between time with the patient and time with the electronic medical record. Now, our questions to patients have to be calculated and patients often complain that physicians do not spend enough time with them."
Healthcare's shift to value-based care is focused on improving the patient while drastically lowering costs. Payers are requiring more data from physicians, which may impede their ability to get to the root of a patient's condition and provide the best care possible.
"The insurance industry has decided the best way to limit costs is to increase the Utilization Review process which delays care and increases the administrative burden on physician offices," Dr. Finkenberg notes.
Payers are requiring providers to conduct more utilization reviews, which are often lengthy. Dr. Finkenberg cites one instance where a payer said a patient needed to undergo a thorough psychological evaluation despite Dr. Finkenberg stating the patient had clear pathology demonstrating the etiology of her pain. A psychological evaluation would have been a waste of the insurer's money and would not have resolved her pain and discomfort.
"The psychological evaluation delayed the patient's treatment and led to poor quality of care. This is a perfect example of how the system has become so much harder to navigate," he says. "Most patients seeking a spine consultation have a three- to four-week waiting period. If you have back pain, you want to see someone tomorrow."
As NASS' advocacy council director, Dr. Finkenberg works with legislators to educate them about challenges healthcare providers face and how legislation impacts their ability to provide high quality care.
"I tell legislators that I am concerned about the provider-patient relationship. The industry seems to be more concerned with decreasing cost than improving quality," Dr. Finkenberg says. "We can't go down that road. If we continue to make it so difficult for people to get care, it is making quality worse."
CMS implemented the Medicare Access and CHIP Reauthorization Act to fall in line with the shift to value-based care, but many providers are concerned the pay-for-performance system will result in a hefty fee for providers. CMS recently offered providers flexibility by allowing them to choose from multiple options as to how they can participate in the first year, yet many providers may still endure a penalty for failing to meet reporting requirements.
Rather than rewarding or punishing physicians, Dr. Finkenberg has a different solution — Reward physicians willing to make an effort to incorporate EHR and Quality Measures in their practice. "After all, the general quality of our healthcare system depends on everyone getting on board," Dr. Finkenberg notes.
"We have to find groups of doctors willing to explore innovative ways to give high quality of care at a reasonable cost," Dr. Finkenberg says. "We need legislation that protects the physician-patient relationship and allows faster access to specialists who can limit inappropriate testing and limit overall disability."
Hospitals around the nation are reducing their services and many providers are seeing less Medicare patients as reimbursement dwindles. CMS data showed 9,539 physicians who had accepted Medicare opted out of the program in 2012, up from 3,700 in 2009.
"Hospitals are decreasing services, limiting staff and closing ORs earlier," says Dr. Finkenberg. "I think the whole system has to change — we have limited resources, fewer physicians and an increasing number of patients. If we do not find a way for physicians, hospitals, insurers and the government to work together, the quality of medicine in the United States is certain to decline. However, I am optimistic as the medical profession will not abandon their patients no matter how hard the system tries to make it."
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