Primary care is in trouble, according to recent reports. The workload of primary care physicians (PCPs) is increasing and there is a provider shortage. Many of the new healthcare models are focused on connecting patients more closely to their PCP. However, studies show that providers are overwhelmed trying to cope with their workload and managing long hours and on-call schedules. The growing amount of paperwork that physicians have to handle has led to their spending more time at work and less time with patients, according to a study by locumstory.com. Medical transcription services can provide the solution to this. A recent Harvard Business Review (HBR) report suggests that another way to reduce PCP workload would be to remove the barriers that stand in the way of separating care from location and empowering patients to take on more of their own care.
According to the HBR report, telemedicine can transform health care delivery. However, telemedicine has not achieved its potential in this respect due to three factors: the excess workload created for the care provider, the likely change in patients’ health-care-use behavior, and the economics of reimbursement.
- Excessive PCP workload: The efforts of policy makers to increase access to primary care are not working because PCPs cannot handle more work than they are already doing. Low reimbursement is discouraging medical students from opting for a career in primary care, further exacerbating the PCP shortage.
- Patients’ health-care-use behavior: Studies showed that the introduction of an e-mail system that allowed patients to email their health concerns to their care team instead of visiting the physician’s office did not have the intended effect. Email made it easier for them to report even their concerns along with photographs. Physicians found it difficult to ignore reported concerns. The result: instead of reducing face-to-face visits, the email system in the portal actually encouraged patients to visit the office more often.
- Reimbursement conditions: Third party payer reimbursement policies are also responsible for limiting innovation in care delivery methods. In many cases, a health care problem can be addressed through a phone call. To get paid, providers need to provide clear evidence that care was medically necessary. As explained earlier, in the new nonvisit care models even minor ailments get reported and create a reimbursable insurance claim. However, the policy of insurers is to tie reimbursement to face-to-face visits in the belief that it will prevent overuse of health care. This requirement can actually have adverse effects and restrict the use of the most efficient methods of care delivery. Remote eye exams for patients with diabetes are an example of convenient, high-quality, low-cost care, says the report. It increases screening rates and preserves vision. However, the paradox is that reimbursement for this service is much lower than an in-office eye exam.
The researchers conclude that care models that increase the connections between patient and provider added to the load of the already-taxed primary care system. The solution, according to them, would be to engage patients in their own monitoring and care. This can be achieved in the following ways:
- Design apps that provide information to the patient rather than the care team
- Encourage patients to monitor their conditions and make treatment adjustments on their own
- Allow technicians and physician extenders such as PAs and nurses to handle baseline care
- Restrict care by the PCP to emergencies and chronic and serious conditions
- In addition to making it easy for patients to understand and act on medical information, guide them on using the information to make decisions to improve their health
- Use financial incentives to encourage medication adherence
- Involve patients’ friends and family members in their care
Reducing patients’ demands on primary care providers is the key to reducing PCP workload, say the researchers.
A study published in the Archives of Internal Medicine in 2012 that was led by Mayo Clinic physicians reported that “invisible tasks” linked to non-face-to-face patient care as the reason for the unsustainable workload of primary care physicians (PCPs). The study identified these invisible tasks as those which physicians don’t get reimbursed for such as
- writing prescriptions
- ordering laboratory tests
- dictating notes
- reviewing notes in electronic health records (EHR) systems, and
- communicating with patients on the phone or email
The researchers noted that increased and uncompensated workload could cause several problems including physician burnout and career dissatisfaction and exacerbation of PCP shortage, besides compromising quality of care and access to care. They concluded that compensating PCPs for these nonvisit tasks and implementing new value based reimbursement models could be the key to ensuring access to primary care in the future.
When it comes to managing electronic health record (EHR) related documentation tasks, outsourcing medical transcription is a proven strategy to reduce stress and improve the work/life balance of PCPs.