Left to our own devices, most of us physicians try our best to provide high-quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many of us get so caught up in our busy clinic schedules we occasionally forget to, say, order mammograms for women overdue for such tests, or we don’t get around to weaning our aging patients from unnecessary and potentially harmful medications.
Because the quality of American medical care is often uneven, third-party payers — insurance companies and government programs like Medicare — increasingly measure clinician performance and reward or punish physicians who provide a particularly high or low quality of care.
The result of all this quality measurement: gazillions of hours of clinic time spent documenting care rather than providing it.
According to one study, in fact, clinic staff spend more than 15 hours per week dealing with quality measures for every physician in the practice. In other words, a six-physician clinic group can expect 90 hours of staff time spent documenting quality performance. And it’s not just the staff who are left to do such documentation. Physicians spend precious time in such activities, too. The same study estimates that physicians spend almost 3 hours per week documenting the quality of their care. Here’s a picture of that finding:
Is it any wonder why so many American physicians report being burned out by their jobs? In fact, according to a Kaiser Family Foundation poll, 70 percent of emergency medicine physicians report being burnt out by their jobs, and over 60 percent of those in family medicine:
The burden of bureaucracy may also explain why so many physicians, when asked what they plan to do with their career in the next few years, anticipate either reducing their time in clinic or switching to alternative practice models, like concierge care, that reduce bureaucratic hassles:
These bureaucratic hassles are extraordinary and need to be fixed. But by no means am I saying that we need to stop measuring health care quality, nor cease basing part of health care reimbursement on quality performance. Instead, we need to take serious steps to reduce the burden of tracking health care quality. Here a few things we could do that would help out:
1. Reduce the number of quality measures clinicians are expected to track and/or be held accountable for–targeting the measures most in need of improving.
2. Standardize measures across payers. We can’t expect clinic staff to track different measures for every insurance company or government program paying for their patient population.
3. Automate as many of these measures as possible, using the electronic medical record (which an increasing number of health care providers are now using).
4. Work more closely with providers to set a balance between tracking and improving quality versus having time for clinicians to interact with their patients.
It does no good to drive clinicians out of their professions by burdening them with an ever-growing, always shifting smorgasbord of quality measures. We need to simplify and standardize quality measures, so clinicians can focus on clinical care.
Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.
Image credit: Shutterstock.com
