Time-Saver May Be Just a Time-Waster?
Electronic medical record (EMR) advocates tout the ability to quickly transfer patient data from one department to another as a key advantage. Recent studies, however, may lead policy-makers and others to question the validity of that claim.
A small 2012 Archives of Internal Medicine study of family practice physicians reported an EMR-associated loss of 48 minutes of free time per clinic day] In an effort to determine the extent of this problem on a broader scale, researchers collaborated with the American College of Physicians in revising the study instrument and surveying a national sample of internists. In the follow-up study—whose results were published in a research letter on JAMA Internal Medicine's website—respondents reported [1]:
- At least one data management function was slower after EMR adoption (89.8%);
- Note-writing took more time (63.9%);
- It took longer to find and review medical record data with the EMR than without it (33.9%); and
- It was slower to read other clinicians' notes (32.2%).
Respondents' loss of free time was "large and pervasive and could decrease access or increase costs of care," according to researchers, who recommended that policy-makers consider these time costs in future EMR mandates. Furthermore, they suggested, "Ambulatory practices may benefit from approaches used by high-performing practices—the use of scribes, standing orders, talking instead of email—to recapture time lost on EMR."
Does Defensive Medicine Really Add Cost?
Only 13% of costs incurred by hospitals can be linked to the overuse of tests, procedures, and hospitalizations owing to fear of malpractice litigation—that is, defensive medicine—according to a study published in JAMA Internal Medicine.[2]
Researchers began with the premise that physicians who were concerned about being sued for medical malpractice would order more tests, et cetera, to keep litigation at bay, and that the result would be higher overall hospitals costs. The study allowed physicians to assess the degree of their orders' defensiveness and assign a grade on a 5-point scale from "not at all defensive" to "completely and only defensive."
Defensive medicine practices were found to vary substantially, but, researchers noted, "Those who wrote the most defensive orders spent less than those who wrote fewer such orders, highlighting the disconnect between physician beliefs about defensive medicine and their contribution to costs."
The study authors concluded that although a large portion of hospital orders had some defensive component, few orders were completely defensive and "physicians' attitudes about defensive medicine did not correlate with cost." These findings might cast doubt on the portion of defensive procedures—and therefore medical costs—that could be reduced by tort reform.
What You May Not Know About Your Will
Is your financial knowledge off-base? Knowing the answer could have a big impact on your and your family's financial future. Charles Schwab's recent Money Myths[3] survey revealed that 91% of respondents who identified themselves as "very" or "extremely savvy" about personal finance agreed with the statement, "A will is the best way to ensure that your estate will be distributed the way you want." In many instances, this is not the case at all.
"Although it's better to have a will than to have nothing, there are situations wills don't govern," advises Eli Uncyk, an attorney in New York City. For example, proceeds of life insurance policies, retirement plans, and IRAs will pass to the beneficiary named on the account. "A will cannot control the payment to the beneficiary, unless the deceased's estate is the designated beneficiary," says Uncyk.
He points out that there are a number of situations in which a trust may be preferable to a will. With many trusts, you can:
Bypass probate. Probate can be a lengthy and costly process—plus its proceedings are public record, so trusts offer a measure of privacy that wills don't. With some trusts, such as a revocable trust, some or all of your assets stay within your control during your lifetime.
Provide for beneficiaries with special needs. A "special needs trust" can benefit a person who may be eligible for social services benefits, because the income and assets of the trust will not be used to determine eligibility for social services. A trust can also ensure better control of inheritances if your beneficiaries may be minor children and grandchildren.
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Limit a surviving spouse's access (or a spouse's children from a prior marriage) to assets if there is no prenuptial agreement waiving a surviving spouse's minimum share.
"To help plan your estate," advises Uncyk, "be sure to consult a legal and tax professional."
You Don't Have to Be a PCMH to Be Patient-Centered
Patient-centered care is hardly the sole province of patient-centered medical homes (PCMHs), concluded the Medical Group Management Association (MGMA) in "Cost Survey for Primary Care Practices: 2013 Report Based on 2012 Data" and "2012 MGMA Patient-Centered Care: Status and Prospects Report."[4]
"It's possible to be truly patient-centered in any model of delivering care," says Susan L. Turney, MD, MGMA president and CEO. "Regardless of model, it requires a proper structure and foundation—the right providers and staff—to truly provide quality and cost-effective care to patients."
MGMA outlined several common factors that the surveyed PCMH practices incorporate to help engage patients more fully in their own care. Does your practice:
- Use technology to streamline patient care and improve outcomes? 58% of surveyed PCMHs exchange clinical information electronically with referral physicians, and 65% use chronic disease registries to conduct population management.
- Have larger staffs? These groups have 37% more business operations staff and 11% more nursing support staff than their non-PCMH counterparts.
- Have higher operating costs and revenue? The median total operating and nonphysician provider cost per patient for a PCMH practice is $245.79, vs $177.11 in a non-PCMH primary care practice. However, PCMH practices reported higher total medical revenue per patient than non-PCMH primary care practices.
- Involve patients and caregivers in care plans? 61% of PCMH practices have patients and caregivers participate directly with staff in developing mutually agreed-upon treatment plans.
- Have smaller patient panels? PCMH practices have a median number of 1518 patients per full-time equivalent (FTE) physician, vs 2498 patients per FTE physician in non-PCMH primary care practices.
If You Could Choose Again, Would You Be a Physician?
More doctors are saying "yes."
Although professional morale is still an issue for many physicians, their outlook has improved compared with prior surveys, according to the Physicians Foundation's "2014 Survey of America's Physicians: Practice Patterns and Perspectives."[5]
Other surveys have linked physician dissatisfaction to high levels of government regulation and reimbursement struggles, among other factors, but this survey found that the mood is trending upward "as their ranks change demographically and as their status rapidly shifts from that of independent practice owner to employee."
The survey polled more than 20,000 physicians on a range of issues. Compared with 2012 results, more doctors are saying they would:
- Choose their careers if they could do it all over again (71% vs 66%);
- Recommend medicine as a career for their children (50% vs 42%); and
- Describe their morale about the state of the medical profession as positive (44% vs 32%).
Of note, across the board on the above, there was considerable divergence between employed physicians and practice owners, with a greater positive outlook for the former. Also of note was the finding that doctors chose patient relationships as the most satisfying aspect of medical practice (79%) over any other factor, including financial rewards, which were cited by only about 15% of physicians.
