In the Journals

Physicians not receiving sufficient reimbursement for ‘desktop medicine’

The amount of time physicians allocate to desktop medicine almost mirrors the amount of time spent with patients, but this time is often not reflected in reimbursement structures, according to research recently published in Health Affairs.

“Fee-for-service payments are intended to reflect relative value units used before, during and after clinical encounters,” Ming Tai-Seale, MPH, PhD, associate director of the Palo Alto Medical Foundation Research Institute in California, and colleagues wrote. “Questions have been raised about whether the reports underlying the [relative value unit] estimates are accurate and representative of true physician effort in providing patient care services.”

To answer some of those queries, Tai-Seale and colleagues evaluated more than 31 million transactions made by 471 physicians in the electronic health records of 765,129 patients. Of the patients, 637,769 were seen at least once in the 2,842,109 face-to-face ambulatory care visits during the 2011 to 2014 study period. Activities such as reviewing test results, sending staff messages, ordering tests, responding to patients’ online requests for prescription or medical advice and communicating with patients through a secure patient portal were considered desktop medicine.

The researchers found that physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine.

“This method of analyzing physician work has far-reaching implications for payment reform,” Tai-Seale and colleagues wrote. “While it may be good or bad that physicians are spending more time documenting care and communicating with other staff members than they are in face-to-face visits with patients, that fact highlights the misalignment of a payment policy that reimburses only office visits, lab work and procedures while overlooking much of desktop medicine work.”

They concluded by noting that CMS intends to watch practices to ensure high quality health care under the Comprehensive Primary Care Plus Models, and offered a way for physicians to keep track of their time that doesn’t involve a lot of effort.

“Access logs provide a simple and unobtrusive way for health care delivery systems to examine how their clinicians spend a significant portion of their time. The effective use of such data can help create true learning health systems capable of assessing how best to deploy clinical and other resources to maximize the value of their services to patients,” they wrote.

Tai-Seale made a few more suggestions in an interview with Healio Family Medicine.

“Many of those desktop medicine activities — such as care coordination and responding to patients’ email — are of high value to the delivery system and to patients, so the staffing, scheduling and design of primary care practices should reflect this value. [Other possible solutions include] having robust teams, so people practice at the top of their training/license. Physicians do less ‘clerical’ work and more physician work, [and] team members could be delegated some desktop medicine tasks currently performed by physicians.” – by Janel Miller

Disclosure: Tai-Seale reports no relevant financial disclosures. Healio Family Medicine was unable to determine the other researchers’ relevant financial disclosures prior to publication.

The amount of time physicians allocate to desktop medicine almost mirrors the amount of time spent with patients, but this time is often not reflected in reimbursement structures, according to research recently published in Health Affairs.

“Fee-for-service payments are intended to reflect relative value units used before, during and after clinical encounters,” Ming Tai-Seale, MPH, PhD, associate director of the Palo Alto Medical Foundation Research Institute in California, and colleagues wrote. “Questions have been raised about whether the reports underlying the [relative value unit] estimates are accurate and representative of true physician effort in providing patient care services.”

To answer some of those queries, Tai-Seale and colleagues evaluated more than 31 million transactions made by 471 physicians in the electronic health records of 765,129 patients. Of the patients, 637,769 were seen at least once in the 2,842,109 face-to-face ambulatory care visits during the 2011 to 2014 study period. Activities such as reviewing test results, sending staff messages, ordering tests, responding to patients’ online requests for prescription or medical advice and communicating with patients through a secure patient portal were considered desktop medicine.

The researchers found that physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine.

“This method of analyzing physician work has far-reaching implications for payment reform,” Tai-Seale and colleagues wrote. “While it may be good or bad that physicians are spending more time documenting care and communicating with other staff members than they are in face-to-face visits with patients, that fact highlights the misalignment of a payment policy that reimburses only office visits, lab work and procedures while overlooking much of desktop medicine work.”

They concluded by noting that CMS intends to watch practices to ensure high quality health care under the Comprehensive Primary Care Plus Models, and offered a way for physicians to keep track of their time that doesn’t involve a lot of effort.

“Access logs provide a simple and unobtrusive way for health care delivery systems to examine how their clinicians spend a significant portion of their time. The effective use of such data can help create true learning health systems capable of assessing how best to deploy clinical and other resources to maximize the value of their services to patients,” they wrote.

Tai-Seale made a few more suggestions in an interview with Healio Family Medicine.

“Many of those desktop medicine activities — such as care coordination and responding to patients’ email — are of high value to the delivery system and to patients, so the staffing, scheduling and design of primary care practices should reflect this value. [Other possible solutions include] having robust teams, so people practice at the top of their training/license. Physicians do less ‘clerical’ work and more physician work, [and] team members could be delegated some desktop medicine tasks currently performed by physicians.” – by Janel Miller

Disclosure: Tai-Seale reports no relevant financial disclosures. Healio Family Medicine was unable to determine the other researchers’ relevant financial disclosures prior to publication.