Currently, it seems like new regulations are being made for doctors every day. While keeping up with these new mandates is burdensome for everyone, it is causing havoc on small practices. Unlike larger groups or hospitals, we just do not have the staff to implement all these changes. Nor can we afford it even if we wanted it. While many proclaim these new requirements, such as Meaningful Use, NCQA, e-prescribing, etc., are going to improve clinical outcomes, many doctors are just not seeing that reality.
How are increasing mandates harmful?
– Doctors need to spend increasing time keeping up with these mandates. Unfortunately, we cannot do everything at the same time so we need to find this time from somewhere. Oftentimes, the only place left is the time we spend with patients. Patient diseases are becoming more complex and new treatments are proliferating. Is it better for a doctor to spend time learning the latest treatment options that can be offered to a patient, or to use that time learning which box to check so our metrics are adequately captured by the regulators?
– When these regulations become standard, often the thinking process goes out the window. For example, prior authorizations for diagnostic tests and medications are often decided by people who are not physicians and just following guidelines. Even when doctors appeal and state the reason why the patient needs a certain procedure or medication, it is often arbritrarily denied. Surely, some clinical reasoning should go into denials for services a doctor feels necessary for their patients. Additionally, doctors have been speaking up against Meaningful Use mandates. Many of us don’t feel the EHR technology is there yet to be clinically useful. Yet, there are metrics in place that we need to record to prove we are using it meaningfully. This disconnect is also hazardous. Doctors need to be data entry clerks to record metrics that we don’t feel beneficial to our patients. Is it better if doctors decide how to use their EHR for the best patient care?
– Implementing the necessary practice changes to keep in compliance is costly. Physicians are probably the only profession that do not receive cost of living increases to our salaries. Our reimbursements are shrinking and stagnating. Overhead costs are soaring. It is already very difficult to keep our doors open financially. Yet, this added burden is being cast around our necks. Isn’t is better for doctors to invest in new services and technology for patient care rather than investing in metrics recording for insurance companies?
– In small practices, staff needs to take on the role of doing this additional work. They too are only human and can do so much. They need to take time away from other tasks to accomplish the requirements set forth. This too is time taken away from patients. Wouldn’t it be better for the staff in a doctor’s office to concentrate on patients?
While data can be a good thing, when it goes over-board it can have the opposite effect of what was intended. We all want improved clinical outcomes. And the spirit of some of these requirements is not all bad. But, when the regulations become the primary goal, patient care will suffer. It is time to put the patient back in the spotlight. They are the ones we are all working for. Time to make regulations that are clinically useful and focus on the patient. And maybe it is time to put doctors in charge of that task rather than executives and politicians.
Copyright secured by Digiprove © 2014 Linda Girgis, MD, FAAFP
