Have you ever wondered whether your eight minutes of face time with your doctor is worth the one or two hours you spend in waiting rooms, driving to and from appointments, or supplying information for digital data entry? Your doctor has probably wondered the same thing.
Most likely, the culprit isn’t your doctor, but a dastardly duo: federal reporting requirements and the industry’s entrenched health insurance model.
Screen Time with Uncle Sam
Since 2011, federal “meaningful use” requirements for electronic health records (EHR) have saddled doctors and staff with onerous reporting tasks. To enforce these tasks, the Centers for Medicare and Medicaid Services (CMS) tied them to reimbursements for doctors who care for government-insured patients. CMS proposed a rule in May that would drop meaningful use by that name. The rule, however, would roll similar requirements into a new, 100-point scale for determining doctors’ reimbursement rates, called the Merit-Based Incentive Payment System (MIPS).
Unless CMS changes course, MIPS and meaningful use will produce the same net result. Federal regulations will continue to strip digital record-keeping of its efficiency, whittling down doctor-patient face time to a few minutes each visit.
The Insurance Mill
These minutes were scarce enough before 2011 and are scarcer now, due to an unintended consequence of the nation’s prevailing health-care payment model, which the Affordable Care Act’s (ACA) individual mandate and penalties reinforced. Most patients pay providers through a third-party, such as an insurance company or the government.
Many doctors who have converted their practices from the third-party payment model to a direct-pay model, such as a direct primary care membership practice, say they need serve only 500 to 1,000 patients per year to make enough money.
By contrast, physicians mired by mainstream insurance typically must treat between 2,000 and 3,000 patients per year to profit adequately—after paying administrative staff to process insurance claims, resolve claim disputes, and track down payments.
Face Time: Why 8 Minutes?
The federal Centers for Disease Control and Prevention pegs the number of physician office visits per year at 300.8 per 100 persons. At this average rate of three visits per patient per year, insurance-only doctors must see patients in their offices between 6,000 and 9,000 times per year.
Dividing these visits evenly among a typical year’s 261 work days, these doctors must pull down between 23 and 34 visits per day. This assumes doctors take off weekends and holidays. It also assumes they never take vacation or call in sick.
At this rate, insurance-model doctors with lower patient panels who work eight, nine, or 10-hour days must serve about three patients per hour. Doctors with larger patient panels must serve four or five per hour. A doctor who must see between three and five patients per hour to stay profitable can afford to spend between 12 and 20 minutes per patient.
If your doctor pays staff to fulfill 100 percent of his or her federal EHR reporting requirements, you might log a “Scrubs’ episode’s worth of face time. If, however, your doctor spends any of this time completing EHR requirements, maintains a large patient panel, works eight-hour days, takes a vacation or sick day any time during the year, or emails a prescription to your pharmacy while in your presence, you might log face time of equal length to a single “Scrubs” segment between commercials.
Patients Pay $52 Billion Opportunity Cost
If doctors’ minutes are scarce, the time patients spend on doctor appointments is costing them billions of dollars. Patients spent 121 minutes per doctor visit in 2010—84 minutes in the office and 37 minutes on the road, according to a study published by the American Journal of Managed Care in 2015.
“The average opportunity cost per visit was $43, which exceeds the average patient’s out-of-pocket payment,” the study’s authors wrote. “Total opportunity costs per year for all physician visits in the United States were $52 billion in 2010.”
Far from increasing the net value physicians offer patients, federal restrictions have placed physician-patient relationships in a chokehold. One culprit is CMS regulations tying reimbursements to cumbersome EHR requirements. Another is providers’ overreliance on third-party payers, a habit ACA further entrenched.
Doctor haste and patient waste should drive more of each to seek market alternatives—if they can find the time.
Michael T. Hamilton is The Heartland Institute’s research fellow for health care policy, author of the weekly Consumer Power Report, and managing editor of Health Care News, an online and print newspaper read by market-minded health care professionals, policy analysts, and 56 percent of lawmakers.