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Why You Spend Two Hours To See Your Doctor For 8 Minutes

August 15, 2016

Consumer Power Report #514. Doctors in the mainstream payment model want to see more of you but can't afford to.

Clock swirl

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 of doctors who care for government-insured patients. CMS proposed a rule in May 2016 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 … and Grind

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 profit at a level acceptable to them.

By contrast, physicians mired by mainstream insurance typically must treat between 2,000 and 3,000 patients per year in order 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.”

Time’s Up

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’ over-reliance 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 (mhamilton@heartland.org) 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 state lawmakers.


IN THIS ISSUE:


FOR BETTER HEALTH CARE ACCESS, PURSUE INTERSTATE LICENSING

Imagine you got a nasty cut that needed stitches while you were vacationing in Florida this summer. Apart from putting a damper on your trip, would you be concerned that you wouldn’t be able to see a Missouri-licensed doctor? Probably not. After all, a doctor based in Orlando is trained the same way as a doctor based in Kansas City; where she’s licensed to practice medicine is an afterthought for most patients. Whether the doctor was based in Florida, California, or some other state, we’re usually confident in the care we’d receive.

This fact is important when we talk about the menu of health care reforms that policymakers should be pursuing. After the passage of Obamacare, much of the health care discussion has focused on demand -- on the insurance that we buy for our health care and its cost. But another significant source of our health care problems is our limited and artificially restricted supply of physicians.

To make health care in this country better, we need to make the supply of doctors a priority -- doctors who are physically present in a state, but also doctors who can reach patients through telemedicine.

Central to achieving this end is the liberalization of interstate licensing for American physicians. Medical licenses should be more like driver’s licenses; a doctor in good standing to practice in one state should be able to provide care to anyone in the country without unnecessary interference from the government.

But with only a few exceptions, American doctors are substantively constrained in their practice by our state lines. State medical boards set the rules for who can practice and how, even though most doctors are trained in exactly the same way. Geography has little to do with the type of training a medical doctor receives, and differences among the requirements of various state licensing boards are usually minor. For underserved Missourians, expanding the number of physicians who can help them would be a significant improvement in their access to care. …

Interstate licensing would also give patients more access to telemedicine services, since doctors would be able to cater to Missourians’ needs without having to go through the burdensome process of relicensing.

The need for true interstate licensing reforms has become more urgent as many medical boards are attempting to cement their power and ensure that doctors have to obtain licenses in every state where they might practice -- restricting competition for patient services in favor of maintaining a near-cartel market environment for these boards.

This has to change. Missourians already use, with confidence, licensed doctors in other states; it’s time our own laws reflect that reality. …

SOURCE: Patrick Ishmael, director of government accountability at Show-Me Institute, in an op-ed for the St. Louis Post-Dispatch


STUDY: CERTIFICATE-OF-NEED (CON) LAWS DRIVE UP ILLINOIS HEALTH CARE COSTS

A new study says certificate of need laws, like the ones on the books in Illinois, are driving up the cost of health care.

New hospitals, birth centers and out-patient care clinics in Illinois are required to get a certificate of need, essentially a government review to see if the facility is needed, before they can even break ground.

A new Mercatus Center study said those requirements make health care more expensive. Illinois’ Health Facilities and Service Review Board reviews and approves certificates of need. The study’s author, James Bailey, said ostensibly the board seeks to control health care costs. But Bailey said certificates of need actually limit the supply of care.

“Not just hospitals -- ambulatory surgery centers, long-term care facilities, neonatal centers, rehabilitation centers, lots of different services,” Bailey said.

Bailey said it’s simple economics: high demand and low supply leads to higher prices. Bailey’s study said care in states such as Illinois is as much as 5 percent higher than in states without certificates of need requirements.

“Health spending, overall, will fall between 3 and 6 percent,” Bailey said. “Charges by hospitals will also fall about 5 or 6 percent.”

Bailey said Indiana saw similar price decreases after lawmakers there ended the state’s certificate of need requirements. …

SOURCE: Illinois News Network Staff


AFFORDABLE CARE ACT RATES MAY JUMP 17.3% IN MICHIGAN

Health plans sold on Michigan’s insurance exchange could see an average 17.3% increase next year, and if recent history is any guide, state regulators could approve the insurance companies’ rate hike requests without many -- if any -- changes.

The rate increases would mean a financial hit for taxpayers in general and the 345,000 Michiganders who buy their health insurance on the Healthcare.gov exchange, created under the Affordable Care Act, also known as Obamacare.

“We really try our hardest to keep coverage affordable, but some of the costs are very difficult to manage when you have pharmacy companies going out with 800% increases on the price of their drugs in a year,” said Marti Lolli, senior vice president of commercial markets for Grand Rapids-based Priority Health, which is asking for an average 13.9% premium increase for its 2017 individual market plans.

Insurance companies in Michigan have been getting their way in rate cases lately. Last year, the state’s Department of Insurance and Financial Services granted every insurer the exact rate increase requested for individual market plans. Those increases averaged 6.5%.

The reasons might be surprising for some: The proposals aren’t judged on affordability but on a set of rules and actuarial equations. It might seem like cold math, but state regulators say certain basic financial conditions have to be met, such as determining whether a company can afford to competitively price its health plans and stay solvent. …

SOURCE: JC Reindl, Detroit Free Press


OHIO TO LAUNCH NEW HEALTH CARE INITIATIVE

The Governor’s Office of Health Transformation will launch a statewide initiative next year designed to improve the quality of primary care with enhanced payments for physicians, while at the same time reducing the cost of care by promoting a more efficient delivery model.

The state has partnered with downtown Dayton-based CareSource and four other Medicaid managed care organizations, along with the four largest commercial health plans and a limited number of primary care practices across the state to implement the new Comprehensive Primary Care (CPC) program. …

The program will allow approved primary care practices to earn bonus payments for providing coordinated care to patients through a team-based delivery model known as patient-centered medical homes.

When the program is fully implemented in 2018, participating primary care doctors will receive monthly bonus payments of about $4 per patient, on average, according to Greg Moody, director of the Governor’s Office of Health Transformation, who said the state has budgeted $60 million in additional Medicaid payments alone in 2018. Commercial insurers will determine their own bonus payments. …

“By working together with our partners in the health care industry, we’ve developed a primary care system that rewards providers who keep costs low, while at the same time help Ohioans lead healthier lives and keep more money in their pockets,” Kasich said in a statement. “Our new effort will better serve those receiving both public and private care, and can serve as a model for other states to follow.”

The Ohio initiative kicks off Jan. 1, 2017 at the same time the federal Centers for Medicare and Medicaid Services will launch a similar program -- the Comprehensive Primary Care Plus, or CPC+ -- program, authorizing Medicare to pay physicians monthly bonuses for primary-care visits.

Practices selected for the CPC+ program will be invited to join the Ohio CPC program. And after Jan. 1, 2018, any practice that meets the state’s requirements may enroll in the Ohio CPC program.

SOURCE: Randy Tucker, Dayton Daily News

Author
Michael Hamilton writes and edits for the liberty-minded clients of Good Comma Editing, LLC, a freelance writing and editing company.
media@heartland.org @MikeFreeMarket