I think part of that is that insurance companies require doctors to do a lot of interaction, rather than their staffs. I’d say that they ought to relax it and maybe allow for a practice manager role of some kind that can do a lot of that interaction on behalf of the provider(s), if they don’t already do that. But right now, there’s a lot of “Get your doctor to submit a pre-approval”, which requires you to call your doctor, talk to their staff, the doctor to approve, then somehow the office submits a request to insurance. All that for you to get a medication that the doctor has already prescribed and that is already on the insurance formulary, albeit apparently with a “must submit preapproval” flag. I can totally see why that sort of thing multiplied by however many patients a day every month is a total PITA for a doctor who wants to do, you know, doctoring.
I don’t really see a way around an EHR though; it’s important for doctors to record their notes, diagnoses, and treatments in some fashion, and right now the only way to offload that would be to do something like either have the doctor narrate what they’re doing and have a service enter/transcribe that later, or have someone right there doing it while they interact with the patient. Both of which could be sketchy with respect to patient confidentiality if not done exactly right. Maybe AI could be helpful in the future with this, but the confidentiality aspects would still remain I suspect. People aren’t really going to be wild about the idea of their visits and what they say being recorded.
AI is being piloted extensively now. Not practical for Peds but providers with slightly less … unstructured … history and physical settings are finding it useful. Scribes are also used by some but the expense has to justified by an increase in productivity. Templates and “dot phrases” (shortcuts that bring up standard blocks) help too. Honestly reading the notes that others enter I think they are often way too wordy, both with new text and bits imported. Too much that is extraneous and impedes both efficient review by a subsequent provider and is not actually what is required to justify the code entered. More words entered does not count as a higher level of work done.
That said I have only a passing awareness of the documentation needs of the Medicare population, especially for those on Medicare Advantage. Payment is tied to the risks of costs of your covered panel, kept track of by accurate entry and documentation of all “Hierarchical condition categories” (HCC) your patients may have. Those are then used to calculate “risk adjustment factors” (RAF). And the HCCs need to be verified as still being true each and every year. Coding every HCC to the greatest specificity every year is vital to getting the RAF that accurately reflects the expected costs of your panel. Which means payment. Which makes sense. Someone who takes care of more complicated and baseline riskier patients and is able to keep them healthier should be rewarded. It is fast to just enter T2DM. Entering in all the still current and new comorbidities and making sure the status of each is documented (hypertension, polyneuropathy, obesity, heart failure, whatever), even if it is unchanged, is time consuming.
The advantage of electronic records is that they don’t depend on doctors’ handwriting! (Not to mention all the other advantages of electronic over paper records when several different people need access to them).
One downside I see over here (even though we don’t have the business of reclaiming funds from insurance companies) is that people complain that the doctor/nurse/whoever is “too busy with the computer” when they expect undivided attention. But how else is the doctor to get up to speed on the patient’s history and update it as well?
Does he bill ANYTHING to insurance? Does he charge anything for office visits? Does he limit the size of his practice?
The concierge practices around here charge roughly 1500-1800 a year to remain on their rolls - but then I believe they bill insurance for office visits. So, likely that’s comparable (200/month = 2400).
The last doctor I left due to going concierge made a decent argument that in my case, it’s something to consider - because I’ve got so many chronic health issues, and someone who had the time to really get a handle on all of them would be beneficial. Yeah, maybe, but at the moment I’m still enough at home in my head that I can manage the coordination.
Having been to doctors in about 6 different “ecosystems” in the past 6 months, each with its own electronic record / patient portal system, I love the increased ability to share info. I messaged one doctor with “forgot to mention this at visit, but scan for unrelated condition done elswhere might be relevant”, and got a response saying “Yep - was able to see that result, thanks!”.
A lot of doctors now, specialists at least, will have a scribe in the room at your visit. This lets the doctor pay attention to you, and only briefly tell the scribe “please note such-and-such procedure is scheduled” or whatever. This transfers the bookkeeping from the expensive asset (the doctor) to the cheaper one (the scribe), freeing up a lot of doctor time. I assume the doctor does some reviewing at the end of the day.
Actually, he can do blood draws for labs in-office, and I thnk he bills insurance for those. Routine labs go to a mobile provider that makes house calls for the blood draws; again, I think insurance covers that via the office billing them.
My M-i-L has mentioned that it would be hard to get back with him if she dropped and went to a Medicare-taking practitioner, so I think he does have a waiting list and, therefore, a limit to the number of patients he handles.
That is partly as a “soft” way to limit what they pay. They know that doctors only have so much time and patience. And they can effectively ration total care that needs pre-approval by the number of people they hire to answer the phone.
Not sure if this is an appropriate thread for this question, but has anyone else experienced increased “nickel and diming” by their PCP? Ours has seemingly increased the frequency of visits needed to renew longstanding prescriptions. Whether related or not, he most often issues 3 mo supplies, instead of the 12 mos allowable. Most recently, he initiated a $30 fee for pre-approvals.
Just seems like a gradually increasing hassle. Not entirely sure whether it is motivated by my doc or the insurance (Blue Cross).
For the most part, our visits consist of, “Everything is fine and unchanged, doc.” “OK - here are your scrips.”