Administrative Burdens, Cost Containment, VBC, and Other Innovations

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Electronic Records

Providers raised many frustrations with electronic health record systems. Themes include the lack of interoperability and growing costs. Many comments focused on trying to get feedback from specialty visits for the purposes of care coordination or documenting completed referrals for procedures including those needed for quality metrics.

“The insurance company obviously knows my patient (had the required test) because they paid the claim. Why is a physician tracking it down at the end of year to get a measly bonus when the people paying the practice are, in fact, the ones who know it happened!?”

“We are the smallest state in the country. Why can’t we have a standardized record system?”

“The state should handle medical records like a public utility. We should all have the same record at a reduced cost. Imagine how much cost savings there would be across the system?”

“The state should provide a tax credit or other solution to help with the costs (of EHRs) for solo and small group practices. This would help us directly and immensely.”

Impact of Value-Based Care Models

All but one provider we spoke with is impacted by participation in value-based care models, including ACOs and the AE program. Feedback related to VBCs is mixed, with feedback leaning towards more critical. Some of the differences in perspectives seem to be related to the size and type of practice, and how fully developed the care team was prior to the introduction to these models of care. Additionally, some of the criticism providers have many not be related to VBC specifically, but to being overburdened administratively by insurance companies in general which is lumped together with feedback on VBCs.  

“Our practice has benefited from (VBC) because we now have new team members like care managers and pharmacists. This helps me take care of my patients better; my patients are pleased.”

“I have found access to data on the quality of my practice instructive, and I have used it to make changes in how I provide care.”

Some of the more critical feedback includes

“I can’t see how it positively impacts my practice; all I see are new administrative jobs.”

“Participating in a value –based model has reduced the number of patients I see by approximately 20 patients per week. Now I spend my ::air quotes:: “extra” time focused on ::air quotes:: “quality” issues. I make the same salary, but access is reduced.

“I feel like the AE program is the worst of all worlds. To keep my salary steady, I have to either push the number of encounters or push documentation and track down things I refer my patients for in order to meet bonus targets. For a provider like me who tries to balance access with quality, it is a losing proposition.”

“I am leaving my practice due to being over paneled directly related to being in a new ACO model of care. I now have hundreds of patients dumped into my panel who I have never seen and will never have time to see. But according to the insurance company, I am responsible for them. I do not feel comfortable with this and so I am moving on.”

“I spend the end of each quarter chasing my quality targets. This limits access to my patients and drives my MA crazy.”

“I am evaluated and paid on metrics like colonoscopies, mammograms, and diabetic eye checks. None of these procedures do I provide myself, and I often have very little influence if the patient gets the care I refer them for. And when they do get the care, I almost never get a note back and must chase it. We can all agree that the patient getting those things is important, but I don’t believe this is working the way we intended it to.”

Other Innovations

When asked about what innovations in care delivery could benefit their ability to practice medicine, several mentioned scribes, including AI scribe models. Others also mentioned other case uses for AI including inbox management. 

“My practice is exploring AI scribes. I am excited for the potential, especially the ability to connect more directly and deeply by having more ability to look at my patient and not my computer.”

“It is exciting to imagine a world where AI may be able to help me manage my portal messages and inbox overall. There’s so much duplication and unnecessary stuff in there. Maybe AI can help?”

The following resources and documents address administrative burdens, the move towards VBCs, and cost-containment: