Is The SGR Fix A Big Mistake?
…[T]he proposed legislation casts in concrete an almost laughably complex and expensive clinical record-keeping regime, while preserving the very volume-enhancing features of fee-for-service payment that caused the SGR problem in the first place. The cure is actually worse, and potentially more expensive, tha[n] the disease we have now.
The SGR fix would basically freeze or severely limit future physician fee updates for Medicare Part B (a serious problem for primary care), while permitting physicians to earn modest “value-based” bonuses if they can document quality measure attainment, cost reductions, participation in alternative payment schemes, practice enhancement activities, or meaningful use of EHRs.
Physicians who meet all these standards could expect to supplement their existing Part B fee by about 4 percent in 2016, going to 10 percent in 2020, with the aggregate bonuses subtracted from the pool of total Part B physician payments to preserve budget neutrality. Non-compliant physicians would see corresponding reductions in their updates…
There also has been in the emerging regime of micro-accountability a heedlessness of the cost in professional time of providing all this “quality” information. Talk to practicing physicians about how they spend their days, and they will tell you that they spend almost as much time coding and documenting their encounters with patients as they do actually practicing medicine.
We are actually helping creating a clinician shortage by commandeering scarce professional time, not merely that of physicians, but advanced practice nurses and the entire clinical support team, to comply with record keeping requirements. As we’ve seen with the “meaningful use” incentives, the 10 percent upside for compliant physicians is probably going to be outweighed by the clinician time and support cost of compliance. We need clinicians to do more caring and less typing.
SGR became law in 1997. In 16 years, the Congress has never shown the slightest inclination to implement the “doc fix” under SGR.
That’s why I think the SGR exists only as a subterfuge.
That is, it allows politicians to claim that future Medicare costs as scored by CBO are under control. Remember CBO is required by law to base its estimates of future Medicare costs on existing law – i.e., SGR.
And then, after the debate has taken place and the public has been hornswoggled once again, Congress then waives SGR and we go to the next year.
SGR is a subterfuge.
I really don’t know what information is recorded in the forms required. But, I think that it is important to keep track of every treatments patients undertake. It is easier for future reference if the procedure was recorded by someone who knows about the issue, not relying on the patient’s version of the story.
It is very important to keep track of patient records because of how valuable they can be when diagnosing future ailments or why they occur. This is also why there are such strict guidelines in regards to patient information such as HIPPA, because of the importance they serve.
A physician knowing the past, especially family history is very effective in providing a patient with the best form of care possible.
The real fun is going to begin in October when ICD-10 hits. Dr.s will be pulling what’s left of their hair out.
” We need clinicians to do more caring and less typing.”
Amen to that!
If only that was possible. I think they are happy sticking with the typing and caring less.
Jay, you couldn’t be MORE wrong about that. I and other doctors grieve the loss of time spent actually listening to, examining, and just being with patients. Instead we are sifting through endless data entry fields, clickboxes, and the like.
Mark B, sure taking a history is important and has been since the dawn of modern medicine. That’s not what this ‘extra’ electronic documentation is about. Digitized health care records could be a great thing– zip those records quickly wherever they are needed. But that’s not what the true purpose is, as it happens. It is about data mining. It is about co-opting the doctor as a miner. The extra data I have to mine (and painstakingly type and click into specific formats in specific places) rarely has anything to do with the patient’s problem or the care I need to render. Sad but true.
Perry, yep. ICD10 implementation is going to wreak further havoc on an already crippled health care system.
“The cure is actually worse, and potentially more expensive, tha[n] the disease we have now.”
Sometimes you just have to live with the current situation if alternatives won’t work.
Changing a bad policy to an even worse policy for the sake of change is not an effective measure of fixing a problem
“Talk to practicing physicians about how they spend their days, and they will tell you that they spend almost as much time coding and documenting their encounters with patients as they do actually practicing medicine.”
They will tell you that, but they could be exaggerating a bit as well.
They could be, but they’re not. I know. This is my life.
I agree with Mr. Goldsmith. Something similar is happening with the Pioneer ACOs (Accountable Acre Organizations). Of 33 that launched in 2012, nine dropped out within the first year. Of those remaining, only nine saved money.
It is jut not worth the hassle for providers to commit seriously to these programs.
Physicians would see corresponding reductions in their updates.
http://www.capscanada.com/
Physicians known what is best for them and providing best care possible.
http://www.mytexasent.com/