By Walter Ray, M.D. and Tim Norbeck

The other day, a staff member of a U.S. Senator reached out to us in an effort to keep them informed and current with health care delivery developments, especially as they relate to physicians and patients. We were delighted by their interest in having such a discussion, and we emphasized those issues which are particularly relevant to physicians today in treating their patients. We suppose that our remarks, by and large, could be construed as a reference guide to the present hostile and intrusive regulatory environment and how it impacts physicians’ practices.

Almost all practicing physicians agree on at least one thing: that their cries for relief from oppressive new regulations go unheeded. No one in Washington really cares what physicians think when it comes to health reform issues. At least that’s what 82 percent of the 20,000-plus physicians who responded to a survey conducted last year. Loss of autonomy and a low morale are natural byproducts of this feeling that their opinion doesn’t matter. For obvious reasons the auto-makers listen to their mechanics; wouldn’t you think that health policy makers would want to listen to physicians?

Richard Baron out to document how much time a doctor spends managing care and discovered that “on a typical day, he or she handles 18.5 phone calls, reads 16.8 emails, processes a dozen prescription refills (not counting those written during a patient visit), interprets 19.5 lab reports, reviews 11 imaging reports and reads and follows up on 13.9 reports from specialists.” Baron added that “this is about meeting the patients’ needs, but it does not generate revenue.” That’s a pretty busy day, and those time allotments don’t even include the actual patient appointments.

Physicians were told that the new, expensive EMR tool would make their professional lives easier. After all, the goal was to facilitate actual coordination of care and cut down on errors and duplication. But in the survey of physicians last year, while 85 percent have EMRs, only 24 percent said they improved efficiency and 47 percent were not happy about having to turn their faces away from the patient towards a computer screen. While most primary care physicians received some aid from the federal government to comply with the transition, they will face financial penalties if they do not use the new system. And the most ludicrous thing of all – the various EMRs are not interoperable with each other. Why is that?

We admit that we are not computer experts, but we have consulted with some who are, and they tell us that there is no good reason for them not being interoperable. Could it be that the IT industry wants it that way?

Furthermore, the ongoing federal role in ensuring “meaningful use” of EMRs is controversial. Many physicians refer to it as “meaningless abuse!”. As Robert Wachter, MD describes it in his new book, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age, there are three stages involved. The first one was designed to make certain that EMRs were being used for health care delivery. Stage 2 tied incentive payments to meeting seventeen fairly aggressive core objectives. Under Stage 3, rules are “tougher, more ambitious and more prescriptive.” Just what overworked physicians laboring in the trenches need: tougher and more prescriptive rules! Dr. Wachter writes very convincingly that “the federal government should prioritize work on interoperability over meaningful use.”

Physicians want more face-to-face time with their patients, not less. Certainly, patients favor more such interaction as well. Quality measurement requirements and new reporting initiatives fly in the face of such wishes. Physicians have complained about being relegated to “box checkers” as they wade through the required 2,167 quality metrics while trying to maintain at least a modicum of eye contact with their patients. “You have a Tower of Babel,” admitted David Blumenthal, who oversaw a report that found attempts to rate care have “unleashed a multitude of uncoordinated, inconsistent, and often duplicative measurement and reporting initiatives.” Truly a mess…but beleaguered physicians must comply with them. If the overseer recognizes such a morass, just imagine the level of frustration that practicing physicians must feel!

And now, physicians and their offices have had to take on the near Herculean task of converting from 14,000 ICD-9 diagnostic codes to roughly 69,000 codes under ICD-10. It has been a very burdensome and expensive process, adding more hassle and more paperwork. Some of these new codes actually include “someone being hurt in a library or a prison swimming pool or at the opera”….bet that happens a lot! And, if you just happen to be sucked into a jet engine, there’s a code for that too! Can anyone say with a straight face that these new codes do anything for patient care? Who dreams these up and exactly who benefits from this added administrative workload? Certainly not physicians. Do patients really benefit from these new codes? We doubt it. The sole beneficiaries of this new scheme seem to be the statisticians and the insurers. Why don’t they incur the costs of the expansion of these codes?

Throw into the mix the Maintenance of Certification (MOC) programs operated by members of the American Board of Medical Specialties (ABMS) with all the other onerous regulatory alphabet soup of demands on physicians, and one can understand why physicians are beside themselves with the unfairness of it all. Critics of MOC programs, and there are many, complain that they are “expensive, time-consuming exercises in busywork.” Clearly, modifications need to be implemented.

Weighing heavily on physicians, particularly those with large numbers of Medicare patients, is how to sustain one’s practice considering that Medicare has raised their reimbursement rates only 4 percent since 2001 while office overheads have increased by over 20 percent.

Hopefully someone in Washington will listen to well-respected economist Paul Ginsberg, President of the non-partisan Center for Studying Health System Change – and not particularly a champion of physicians – when he said, “Medicare has really been pushing its luck with physicians.”

We have one important suggestion that, if implemented, would help patients and physicians immeasurably. Actually it was first put forward some time ago by, Joe Valenti, MD. Dr. Valenti, an OB-GYN from Denton County, Texas believes that two important questions should be asked whenever any new healthcare regulatory measures are proposed:

1. How do they benefit the patient?

2. How do they help physicians help their patients?

If the answer is that they don’t, then they should be scrapped.

In closing, we refer to author Malcolm Gladwell’s observations about the challenges physicians face every day in their practices go directly to the heart of the issue and why relief must be sought. “I don’t understand, given the constraints physicians have in doing their jobs and the paperwork demanded of them, why people want to be physicians. I think we have made it very, very difficult for them to perform their job. I think that’s a shame. My principal concern is the amount of time and attention spent worrying about the business side. You don’t train someone for all of those years of medical school and residency, particularly people who want to help others optimize their physical and psychological health, and then have them run a claims processing operation for insurance companies!”

To paraphrase Winston Churchill, “Whatever the strategy, you should occasionally look at the results.” Is anyone listening?