Despite technology, PCPs bogged down with uncompensated tasks
Primary care physicians are bogged down with tasks that they aren't compensated for, even if they have technology that supposedly saves them time, according to recent survey findings (ppt.) by medical software company Epocrates. The national survey of primary care physicians looked at a variety of issues, ranging from technology adoption to discussing the cost of care with patients. Like last year, I had the opportunity to discuss some of the findings with a primary care physician whose practice is representative of some of the survey respondents (as well as a slice of FiercePracticeManagment readers).
Dr. Jeffrey Kagan, an internal medicine physician, described his Connecticut practice, where he works with one physician partner and a nurse practitioner, as "doing it all" in terms of meeting patients' primary care needs. This includes not only seeing patients in the office but also in the hospital or nursing home and sometimes at home.
Like many of the 632 Epocrates users surveyed, Kagan has used various modes of technology to transform his practice in recent years, with the most prevalent tools being the 14 desktop computers set up throughout the office, including each exam room, the front desk, and in each provider's office. The practice also owns three laptop computers, which the providers sometimes bring when they see patients at the nursing home. However, when traveling to the hospital (the group does not use hospitalists), Kagan and his colleagues use the hospital's laptops, which are connected to a separate electronic medical records system from their own.
The practice, however, has not yet joined the 20 percent of physicians surveyed who currently use a tablet in their medical practice. Although the hospital invites physicians to use their own iPads or similar devices while seeing patients there, Kagan said he'd prefer the hospital supplied its own tablets for the physicians to use.
"You're used to carrying your stethoscope around your neck, but you're not used to having a computer you might leave and come back and not find," he said.
Even without jumping on the tablet bandwagon (44 percent of survey respondents plan to purchase a tablet within the next year), Kagan said he saves documentation time by either remotely connecting one of the laptops to his office desktop via Wi-Fi or by syncing his offline notes once he returns to the office. He also credited technology with making certain tasks, such as prescription writing, exponentially faster than it was in the past.
"We used to have patients drop off refill requests and pick them up sometimes the next day," he said. "But today I just did seven of them, and it took me exactly one minute."
But for every minute the click of a mouse saves during Kagan's day, the administrative burden of practicing today means he still regularly spends hours in the office after patients leave, plus weekend time, catching up on paperwork and other administrative tasks. For example, he spends time dedicated to Meaningful Use attestation requirements that will provide federal funding for the EMR system the practice adopted in February 2010.
Thus, it comes as no surprise to Kagan that 52 percent of those surveyed cited lack of work-life balance as their top practice challenge, following lower reimbursements (57 percent) and tied with lack of time with patients.
"I left the office at 9 p.m. last night," Kagan said. "I signed a whole bunch of papers for people who went to physical therapy...I did drug preauthorizations...I did forms for people getting supplies for diabetic testing...."
He added, "The biggest hassle we deal with on a daily basis is getting preauthorizations on imaging." Like a lot of doctors, Kagan lamented, "There is no reimbursement for that. It sucks up time, and it sucks up money."
According to Epocrates Market Research, an average of 10 percent of physicians' daily activities involve administrative duties (though that seems conservative in comparison to other reports).
Nonetheless, Kagan was also in agreement with the nearly 60 percent of doctors who rank falling reimbursements as a top stressor. As for handling the annual threat of severely slashed Medicare payments, Kagan says he's been in practice long enough to know to "store up his nuts for the winter" in anticipation of a pay freeze, cut, or halt on claims processesing. "I call it the squirrel theory," he said.