“I don’t have the time…I don’t get reimbursed for that.” This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.
I get it. Primary care physicians in particular are under tremendous pressure to produce. Just imagine…physicians in small primary care practices spend about 3.5 hours/week just on dealing with insurance-related paperwork. Then there’s keeping up with recommended treatment guidelines, journals, and IT issues and routine staffing issues…not to mention routine patient care, much of which they in fact don not get paid for. Physicians do have it rough right now.
But Doctors Can Sometimes Be Their Own Worst Enemies
Currently, in just about every State, there are health-plan sponsored pay-for-performance (P4P) and medical home initiatives that reimburse primary care physicians 20% to 30% more for engaging in activities (often of the physicians choosing) aimed at improving quality and patient outcomes. Some of these initiatives provide additional reimbursement for meeting certain prevention and treatment targets, like making sure that X% of type 2 diabetics have their A1C checked X times a year and the so on. The evidence shows that small steps like these can collectively have big payoffs in terms of improved quality and outcomes.
Take patient education and chronic care. Up to 90% of care management for diabetes is provided by the patient and their family. The quality of self-care among diabetics is a key determinant of patient outcomes. Patients that engage in high quality self-care have fewer ER visits, fewer re-hospitalizations, have lower risk of complications and a better quality of life. There is probably evidence out there somewhere which shows that better self-care results in fewer office visits as well. Yet studies show that primary care physicians spend less than 60 seconds per visit engaging in any form of patient education, including self-care management often because they “don’t have the time.”
Think about it for a second. Physicians can (and do) actually make more money and freeing up more time in their practice (be more productive) by doing the very things they “don’t have the time” and “are not paid to do.”
The “lack of time and poor reimbursement” mantra hopefully will soon run its course if for no other reason than increasingly it is no longer as accurate as it once was. But there is another important reason it should go away. When patients read in blogs like this and KevinMD, that doctors appear to be withholding care for lack of time or money, they begin to lose trust in the doctors. They legitimately wonder what needed health services their doctor is withholding from them. What is my doctor not doing for me that he/she is not telling me? If you doubt me, just check out the non-physician, e.g. patient, comments.
And when patients no longer trust their doctors where will that leave us?
That’s what I think. What’s your opinion?
Heisler, M. “Actively Engaging Patients in Treatment Decision Making and Monitoring as a Strategy to Improve Hypertension Outcomes in Diabetes Mellitus.” Circulation. 2008:117; 1355–1357.
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