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Monday, February 26, 2018

A Time-Motion Study of Primary Care Physicians’ Work in the Electronic Health Record Era

Study finds, "Primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits." Seems about right. I spend on average 3 hours on the EMR at the end of each day apart from the actual patient visit. Due to the EMR burdens, some PCPs have decided to forgo third party insurance contracting and to adopt a cash pay only model (Direct Primary Care, DPC). That model cannot work for all, however, because while a patient may be willing to go off insurance and pay a few dollars out of pocket for a routine PCP visit, it is unlikely they will have deep enough pockets to do so for specialty services like cardiology or orthopedics where a visit may entail orders for a CT scan, echocardiogram, stress testing, cardiac catheterization, joint replacement, rehab, injections and lab work. That would all be too costly to do off insurance. The current system is perfectly designed to perform as it does. The purpose of any for-profit insurance product is to make money. Whether its customers have better health is a secondary issue, not the primary objective. Ideally, an insurer wants to collect premiums and never fulfill a claim. That would maximize profits. However, if the insurer receives a claim then the object becomes to deny the claim or to make it as burdensome as possible to fulfill. If the insurer absolutely cannot avoid paying the claim, then under pay the claim. And, this is exactly what we see in health insurance today. What's the solution?
from Rajesh Harrykissoon, MD

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