Tag: CDI

EMRs Taking Away Close to One-Third of Physicians’ Work Time – AMA

The EMR Time Crunch

A common complaint among physicians across practices and specialties has been the amount of time that was previously spent attending to patients is now being occupied by clinical documentation.  These time disparities can have adverse effects on physician-patient relationships, and also limit the number of patients able to receive care from a physician or practice. Value-based purchasing models are frequently the basis for physician reimbursements, and because these models require extensive documentation to accurately report the quality and cost of care, the EMR software physicians are required to use is becoming increasingly complex and time consuming.

AMA Findings

A recent study conducted by the American Medical Association focusing specifically on the use of electronic health records in academic centers concluded that an average of 27% of the participating Ophthalmologists’ time spent on patient examinations was occupied by EMR use. On average a total of 5.8 minutes per patient and 3.7 hours was spent working in EMR on any given full day of clinic.  The study also found a negative association between the amount of time spent on EMR per patient encounter and overall clinic patient volume.

The AMA study concluded what many physicians have been expressing for years: doctors have limited time to spend with patients while they are spending more time within EMRs. Aside from the strain EMR places on physicians’ time and patient relationships, it is also creating cumbersome clerical burdens when completed incorrectly or hastily. Large swaths of copied and pasted text create bloated and messy records, and a lack of training and technical knowledge can result in incorrect coding, medical errors, and frequent interruptions in the documentation process.

Physician Dissatisfaction

The amount of physician dissatisfaction has also grown with the increased implementation of EMRs. Nearly half of all physicians report feeling unsatisfied with their work-life balance, and 57% of physicians display signs of burnout. The additional time requirements of clinical documentation are a significant factor in both of these statistics. Physicians are spending an increasing amount of time outside of regular work hours completing EMRs, and an increasingly less amount of time on actual patient care and interaction. This has led to heightened levels of stress and job dissatisfaction.

Looking Forward

While the path hasn’t always been an easy one, electronic medical records are here to stay, and they do present a plethora of benefits to clinical documentation, patient care, and bottom lines. The challenge that needs to be addressed is how to make EMRs efficient and thorough, while minimizing the amount of time physicians are required to spend on them.  Perhaps the solution for better EMR efficiency lies within a hybrid workflow — a workflow that combines the traditional model of medical transcription, where physicians dictate patient encounters and trained transcriptionists and coders review the reports for accuracy and sufficiency, combined with the advantages of using a modern day EMR is the most efficient way to ensure document quality and lessen the time burden EMRs place on physicians. When the responsibility of clinical documentation is not placed solely on the physician, doctors will be able to attend to more patients, improve patient relationships, and increase their job satisfaction.

Hospital outpatient departments to be impacted significantly by 2017 OPPS Final Rule from CMS

cms-announces-big-changes-in-payments-to-hospitalsCenter for Medicare & Medicaid Services (CMS) has released its Final Rule for Hospital Outpatient Prospective Payment System  OPPS) for CY2017 with significant implications to hospital outpatient departments.

Let me first give you the good news. For CY 2017, CMS is updating OPPS rates by 1.65 percent. The change is based on the projected hospital market basket increase of 2.7 percent minus both a 0.3 percentage point adjustment for multi-factor productivity (MFP) and a 0.75 percentage point adjustment required by law. After considering all other policy changes finalized under the OPPS, including estimated spending for pass-through payments, CMS estimates a 1.7 percent payment increase (before taking into account changes in volume and case mix) for hospitals paid under the OPPS in CY 2017.

Now a little background before the not so good news. Over the last few years hospitals have aggressively acquired physician practices and gained much with such acquisitions because the hospital OPPS rates were higher than MPFS of independent practices. There has been quite a bit frustration over this discrepancy resulting in a regulatory change by US Congress (SECTION 603 OF THE BIPARTISAN BUDGET ACT OF 2015 – aka Site Neutral Payments Provision) and now CMS is trying to fix this gap and equalize the playing field.

As required by the statute, the final rule with comment period provides that certain items and services furnished by certain off-campus Provider Based Departments (PBDs) shall not be considered covered outpatient department services for purposes of OPPS payment and shall instead be paid “under the applicable payment system” (which will be Medical Physician Fee Schedule (MPFS) beginning January 1, 2017. In order to make the transition convenient and to reduce the burden of the change, CMS has identified certain items and services are exceptions from this rule – meaning that these items and services can still be billed at the OPPS rates.

Physicians in PBDs furnishing non-excepted services will continue to be paid on the professional claim and will be paid at the facility rate under the MPFS consistent with current payment policies for physicians practicing in an institutional setting. However hospitals the payment rate for the technical component of the services will generally be 50 percent of the OPPS rate.

The second significant change is that CMS believes that a basic tenet of a prospective payment system is the packaging of all integral, ancillary, supportive, dependent, or adjunctive services into primary services. For CY 2017, CMS is finalizing policy refinements with respect to packaging. Packaging Based on Claim instead of Based on Date of Service. CMS is finalizing its proposal to align the packaging logic for all of the conditional packaging status indicators so that packaging would occur at the claim level (instead of based on the date of service) to promote consistency and ensure that items and services that are provided during a hospital stay that may span more than one day are packaged according to OPPS packaging policies.

Changes in Hospital Value Based Purchasing Program (VBP)

CMS received feedback that some stakeholders are concerned about the pain management dimension questions being used in the Hospital VBP Program, believing that the linkage of these particular questions to the Hospital VBP Program payment incentives creates pressure on hospital staff to prescribe more opioids in order to achieve higher scores on this dimension. Keeping this in view, in the CY 2017 OPPS/ASC final rule with comment period, CMS is finalizing its proposal to remove the pain management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for purposes of the Hospital VBP Program, beginning with the FY 2018 program year. CMS is also developing and field testing alternative questions related to provider communications and pain in order to remove any potential ambiguity in the HCAHPS survey.

Changes to Hospital Outpatient Quality Reporting Program (OQR)

The Hospital OQR Program is a quality reporting program for outpatient hospital services. The Hospital OQR Program requires hospital outpatient facilities to meet certain requirements, or receive a reduction of 2.0 percentage points in their annual payment update for failure to meet these requirements. In the CY 2017 OPPS/ASC final rule, CMS is finalizing the addition of seven measures to the Hospital OQR Program for the CY 2020 payment determination and subsequent years. CMS did not propose any changes to the CY 2018 and CY 2019 Hospital OQR Program measure sets, which include 26 measures—25 required and one voluntary.

Ambulatory Surgical Center Quality Reporting (ASCQR) Program

The ASCQR Program is a pay-for-reporting program that requires ambulatory surgical centers to meet certain requirements or receive a reduction of 2.0 percentage points in their annual payment update for failure to meet the requirements. In the CY 2017 CMS is finalizing the addition of seven measures to the ASCQR program measure set for the CY 2020 payment determination and subsequent years. CMS did not propose any changes to the CY 2018 and CY 2019 ASCQR Program measure sets, which include 12 measures—11 required and one voluntary.