In the past 18 months primary care physician offices have adapted to medicare rules, particularly those related to Accountable Care Organization (ACO). These requirements add additional testing, interview questions, and electronic records. You may have noticed the difference when you visit your physician.
Here are some that are required on all patients:
- Depression screening handout that must be completed by the patient
- Fall risk assessment
- Tobacco use assessment
- Electronic Medical Records (EHR) meeting Meaningful Use 2 criteria
What frightens some is that the government is checking to see if physicians are screening their patients for depression. Do patients want the government knowing their depression scores? Shouldn’t that remain between the patient and the medical professional? The same goes for fall risk and tobacco use.
What is also difficult is the way the physician is required to document these data elements. The documentation templates require a lot more information than is necessary. Do you wait a long time in your physician’s waiting room? Get ready to wait longer.
The EHR requirement adds 20-30% more documentation time to the physician’s workload. I spoke to one of my physician colleagues about his EHR experience. His response was that he used to get home at 6:30pm. Now he gets home at 8:30pm and has a headache. Of course he does: he has been typing and staring at a computer screen a good part of the day.
Some of you may notice your physician paying less attention to you and more attention to the computer terminal in the exam room. Yep. That is a common complaint. The EHR interrupts the physician-patient relationship.
One might think that these requirements are driven by physicians and nurses seeking to improve patient care. From what I can tell, most of the changes are driven by other forces and factors: accountants wanting a clear way to determine level of pay for visits, compliance officers wanting to check boxes, and cost control officers trying to diminish expensive visits such as ER visits and ICU hospitalizations.
Since the physician was not at the decision table, what we have is a round system being stuffed into a square hole. Much work needs to be done (and is being done) on improving the physician-EHR and physician-ACO interface.
After a physician visit, do you feel more like a number? Do you feel like your physician was clicking checklists instead focusing on you? Does the computerized record have a higher place on the totem pole than you? If you feel this way you are not alone. All physician offices have changed. We aren’t the same.
In this new world of medicine, I have two recommendations for patients. The first is that you should not leave the office until you are certain your physician has heard and addressed your pertinent issues. Your doctor might not be able to address every little item, but s/he should needs to pay attention to the vital ones. Second, be patient with your physician and her/his office. All offices are in transition, which means extra work and headache for everyone.
Let me conclude by mentioning that the hospice nurse-patient relationship remains one of those areas of medicine least affected by the regulation torrent. A hospice nurse spends 45-60 minutes, sometimes longer with each patient. It is enough time to overcome the deficiencies introduced by EHR and government regulation. In fact, in the hospice world, we welcome EHR for all of its security, legibility and organizational improvements.
Hospice care is such an intimate interaction of trust between two individuals. All the patients’ needs are laid bare. A human being has resigned her/his-self to leaving this world. What an emotional time! What a responsibility for the hospice team. What a trying time for the family.
I mention these peculiarities about hospice to help us understand that medical and spiritual care happens through and around the organizational components, the tools in the hand of the nurse, chaplain, aide and social worker. In a healthy hospice environment, these tools remain servants of the patients and family.