Tags: Healthcare Reform | Medicaid | doctors | healthcare

Doctor: Bureaucracy Consuming Time That Should Be Spent With Patients

By    |   Friday, 12 September 2014 01:00 PM

Modern-day medicine has become a quagmire of bureaucracy that consumes time that doctors should be using caring for their patients, says Dr. Mark Sklar, an assistant professor of medicine at the Georgetown University Medical Center and at the George Washington University Medical Center.

If high-quality medical care is the goal, the bureaucracies need to be tamed," Sklar writes in an opinion piece for Thursday's edition of The Wall Street Journal.

"Our government and insurance companies understandably want to measure outcomes of healthcare dollars spent. However, if the healthcare system rewards data entry, that is what it will get — the quality of care seems an afterthought."

Recent polls back up Sklar's contentions. A Washington Post-ABC News survey showed that 29 percent of the 1,000 adults surveyed said that their care is getting worse under the Affordable Care Act. Only 14 percent say coverage is better, while 53 percent said it has remained the same.

The findings back up other recent polls that show the public has soured on Obamacare even as many don't think it should be repealed. Instead, they want it fixed.

In a Kaiser Family Foundation poll, nearly 3 in 5 Americans said they would prefer to see their representatives in Congress "work to improve" the healthcare law rather than "work to repeal the law and replace it with something else."

The constant bureaucratic distractions consume so much time that Sklar finds himself giving up his personal time so he has time during office hours to care for patients, and the endocrinologist, who has been in practice for years, said that while Obamacare has caused a huge impact on patient care, but actually, the practice of medicine has actually been changing since 1990.

In the 1990s, insurance companies started developing managed-care plans that increased profits "at the expense of the physician," and with Obamacare, "we are seeing new groups profiting from changes to the healthcare system," Sklar said.

Meanwhile, he wrote, Accountable Care Organizations organize doctors into groups from which they take a percentage of income, and because physicians now must use electronic medical records, companies harvest money from practices and hospitals.

"The push to use electronic medical records has had more than financial costs," writes Sklar. "Although it is convenient to have patient records accessible on the Internet, the data processing involved has been extremely time consuming — a sentiment echoed by most of my colleagues."

A consultant told Sklar to enter data into the record during office visits, but he found that that to be a disruption that kept patients from discussing their medical problems.

"Yet to avoid future financial penalties from Medicare, I must demonstrate 'meaningful use' of the electronic record," Sklar said. "This involves documenting that I covered a checklist of items during the office visit, so I spend 90 minutes each day entering mostly meaningless data. This is time better spent calling patients to answer questions or keeping updated with the medical literature."

In addition, electronic records can not be shared unless doctors work in the same healthcare system, so they do not yet improve costs and patient care.

Sklar said that patients are also slow to change. His office adapted Medicare requirements for prescribing medications electronically, but patients don't want their prescriptions sent that way.

"They want a physical copy — either because they don't trust the Internet or because they don't need to fill the prescription immediately," he said. But that causes a problem, because if he doesn't prescribe electronically for a certain percentage of Medicare patients, he loses reimbursement in amounts that could reach up to five percent.

Insurers are also increasingly requiring pre-authorizations for medications, which means doctors offices must call a number, be re-routed and then put on hold for a representative, which can take a half-hour or more to happen.

"Rather than having physicians pre-authorize expensive medications, the outrageous costs of many non-generic medications must be addressed," he said. "I understand that pharmaceutical companies need to make profits to cover investments in drug development. However, they should have some compassion for their customers."

Sklar must also take part in the Physician Quality Reporting System which uses diagnostic codes for billing insurance. An upcoming modification will only expand that requirement, and the system turns physicians "into adjuncts of the Census Bureau who spend time searching for codes."

The patient, not the government should be who judges medical choices, said Sklar.

"To give people more control of their medical choices, we should move away from third-party payment," said Sklar.

"It may be more prudent to offer the public a high-deductible insurance plan with a tax-deductible medical savings account that people could use until the insurance deductible is reached. Members of the public thus would be spending their own healthcare dollars and have an incentive to shop around for better value. This would encourage competition among providers and ultimately lower healthcare costs."

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Modern-day medicine has become a quagmire of bureaucracy that consumes time that doctors should be using caring for their patients, says Dr. Mark Sklar, an assistant professor of medicine at the Georgetown University Medical Center and at the George Washington University Medical Center.
Medicaid, doctors, healthcare
Friday, 12 September 2014 01:00 PM
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