5MinuteConsult Journal Club

125 Million Hours Lost Per Year

Reference

JAMA Intern Med. Published online March 28, 2022. doi:10.1001/jamainternmed.2022.0372

Study Summary

Cross-sectional survey of 1500 office-based physician evaluating the time spent on documentation outside office hours. Most participants were men and were physicians aged ≥50.

64% were satisfied with their EHR and found documentation to be easy.

Just over half felt time spent documenting was inappropriate and reduced time with patients, and 85% thought documentation for billing increased documentation time.

Outcomes estimated physicians spent 1.8 hours outside of office hours per day completing documentation. Physicians who used EHRs and those who participated in accountable-care organizations or pay-for-performance programs spent more time documenting outside of office hours than those who did not. These results did not differ by specialty. The author estimated U.S. ambulatory physicians spent an approximately 125 million hours outside of office hours completing documentation.

Discussion

Surprisingly almost 2/3s of those surveyed were satisfied with their EHR. Couple that with the belief that the documentation was mostly for billing, and you result a large amount of time, energy and thought spent in consumption of non-clinical time.

One could argue this make the case for having scribes. But if the argument of documentation for billing holds true, the answer is not necessarily a scribe, but an improved health care payment system that focuses on brief but accurate documentation that is uncoupled from reimbursement.

This is not a pipe dream, but rather an inevitability, as the US healthcare system’s current incentive-based payment system is not sustainable. So called “pay for performance” method of reimbursement, based upon documentation, will continue to be a financial drain until lawmakers focus on a system that covers best care without the financial incentive of “do more to bill more." Sadly, I will likely be retired or gone by then…

Contributed by Frank J. Domino, April 27, 2022