Reimbursement System Detrimental To Patient Care
By Greg Bengel, contributing writer
One healthcare provider blames the fee-for-service reimbursement system for physicians’ unwillingness to accept new technologies that will improve patient care and reduce physician workload
“We, as a nation, have chosen not to pay for healthcare, but we handsomely reward disease care. The resulting fee-for-service system penalizes efficiency and rewards work.”
This is a quote from David Voran, M.D., Assistant Professor and Informatics Director of Community and Family Medicine at Truman Medical Center and Medical Director of the Innovation Clinic at Platte City for Heartland Health, in his recent article in Information Week Healthcare titled, “Healthcare Apps Could Be Doctor's Best Friend.” It is a fascinating and insightful article that everyone in the industry should read, as it takes a hard, calculating look at healthcare’s current reimbursement system, its reluctance to embrace technology, and what must change to improve patient care.
Voran says, “Most physicians detest the volume of strokes and clicks required by EHRs and scoff at the very idea that these systems could actually help them reduce their workload.” He continues: “Unlike most other industries, which are leveraging technology by pushing as much transaction processing to the consumer, healthcare insists on doing all of the heavy lifting.” Why is this? Why are so many physicians opposed to technological innovation? Why do so many reject the smartphone apps and EHRs that could help improve health for patients and reduce workload for providers?
Voran’s answer? “Providers cough up numerous reasons to explain why they don’t want patients contributing the data needed to improve healthcare,” says Voran, “but they all boil down to one: It doesn’t pay.”
According to Voran, the fee-for-service model is the culprit. “Physicians and healthcare bureaucracy are slaves to the fee-for-service model and the related work Relative Unit (wRVU) used to calculate physician productivity,” Voran writes. “RVUs are not awarded to managing devices, apps or patient-generated data. Very few organizations leverage reimbursable telemedicine consults or apply them to patient data management. A face-to-face visit is simply too lucrative compared to a virtual visit.”
He further points out physicians – often competitive people – are “easy prey to administrative and peer pressure that exalts big RVU numbers.” Many base their actions solely on producing an RVU, and therefore are completely uninterested in the new technology that would actually make a difference for both themselves and for their patients around the country.
Also on the hook in the article are the 10-minute doctor visits in an “8 x 10 jail-cell-style exam room.” This “cattle call approach to patient care” is a byproduct of the fee-for-service model, in Voran’s eyes, as doctors are incentivized to not actually take the time to help patients change their lifestyles, but simply to move on to another patient, “like well-paid hamsters on wheels.”
As evidence, Voran points us to a study that shows that doctors spend an average of 1.3 minutes explaining crucial information to their patients about both their condition in their treatment during their visits. To make the case that these rushed visits are detrimental to patient care, Voran points us to an additional study called “Time and the Patient-Physician Relationship” from Drs. David C. Dugdale, Ronald Epstein and Steven Z. Pantilat.
According to Voran, this situation will continue to be healthcare’s reality until the fee-for-service reimbursement system is done away with.