As a physician, not a day goes by without a new acronym I need to look up, a new policy I need to follow, another box I need to click or another criteria I need to meet—and this is just to keep up. While the health care picture and its various unknowns loom ever larger in the news, and health information emails overstuff my inbox, it is worth noting that in the midst of all the new legislative, corporate and regulatory initiatives are many individuals just trying to deliver good medical care to patients. It’s not enough to just have an EMR these days; you need to have a team of people capable of explaining the multitude of imperatives being slung at you from all directions that, inevitably, will show up in said EMR.
Recently, the New England Journal of Medicine (NEJM) published an article promoting the concept of the physician as financial counselor. The article suggests that physicians should take time to discuss the cost of care with their patients. Really? Shall I do this while I am examining their eyes and ears? Or, maybe when they are telling me how they learned to cut their wrists to relieve tension? I don’t think I am the only physician in the country who was a bit taken aback by that article.
Here’s another recommendation: The American Academy of Pediatrics (AAP) strongly suggests that, in addition to the mainstay pediatric questions, we need to have discussions about TV and mobile screen time, guns in the home, managing violence, bullying, postpartum depression, and the list goes on. Anything else?
Don’t get me wrong. I think all these issues are important and worth discussing. But as it turns out, the more thorough I am the further behind I get. Just asking an adolescent female about her periods takes ten minutes.
And then, of course, there is the documentation of the visit, made somewhat more dizzying by the number of entries required by Stage 2 Meaningful Use, Pay-for-Performance, Patient-Centered Medical Home status, etc. EMR vendors need to be as knowledgeable about these requirements as clinicians, and must take them into account as they build and enhance their user interface and workflow, all so that I can focus on what I do best – provide care.
I mentioned acronyms earlier, and that’s because they’re inescapable. There’s an explosion of the creation and use of acronyms littered throughout health care, for just about everything: ACO, ACA, CMS, HIE, ICD-10… it’s becoming a nightmarish tangle of letters and terms. And each acronym’s accompanying mandate adds to the volume of information we need to keep up with just to stay in practice. How are physicians to keep pace in this seemingly endless line of red tape? I don’t think we can, at least not without help anyway.
I’m looking up terms far too often these days, and I know that when I need to google a term, I am in trouble.
It goes like this: I need to understand what the PHO is telling me about the shared risk contract, how the ACA affects patient co-pays for a WCC if you bill a 25 modifier, and that the ABP needs me to complete my MOC before 2015. No kidding. It’s nuts out there.
I believe this frenetic and dynamic work life we live as physicians is taking its toll. There are more and more primary care physicians retiring—often early—and fewer and fewer medical students interested in taking their places. Even my physician friends who I view as extremely easygoing and positive are finding it increasingly difficult to keep smiling.
There is a growing disconnect between how physicians define good health care and what lawyers, politicians, and insurance executives view as “quality health care.” Most of the decision-makers have never even seen a patient or provided care, yet they can—and they do—dictate how health care is delivered. They are counting on us being overwhelmed and under-organized.
Doctors are selling out to big hospital corporations in dizzying numbers. Fewer and fewer independent groups will have the resources or the wherewithal to remain standing. This is why it is increasingly important that we make sure our EMR vendors have our backs, and become a partner in addressing our needs. After all, an EMR is where all this stuff shows up. This is a tool that actually affects my rhythms during the encounter. This is where I can sink or swim when it comes to certain mandates and demands. The EMR vendor’s role and expectations are changing just as ours are, but the key is finding the vendors that realize that.
Dr. Sally Ginsburg is an athenahealth client and a pediatrician at Pioneer Valley Pediatrics in western Massachusetts.