The results of these rushed visits may include "decreased patient satisfaction, increased patient turnover, or inappropriate prescribing." Reimbursement formulas encourage physicians to perform much more lucrative procedures. They enable physicians to bypass the time required to really help patients make the changes needed and move quickly on to another patient.
Undoing years of unhealthy lifestyle practices requires deep involvement in a patient's life -- much more than is possible from a 10-minute visit in a cramped exam room. It also requires orders of magnitude more data than is entered into electronic medical records. Physicians need more granular "big data" in order to establish more meaningful relationships with patients and help them undertake lifestyle changes to improve health, reduce disease and lower healthcare costs.
[ Patient generated data could lower costs and improve the quality of care, but it needs to be done right. Read How Patient Generated Data Changes Healthcare. ]
It also requires much more frequent contact than these brief encounters in claustrophobic boxes can provide. (Besides, who wants to work in a jail cell?) In fact, one study showed that doctors spent on average 1.3 minutes conveying crucial information to patients about their condition and treatment during visits.
Meanwhile, a huge wave of smartphone apps and self-tracking devices could help us move toward the goal of improving health and managing diseases. These apps and devices are beginning to empower individuals with tools that make it easier to change. They generate exactly the type of data physicians need to help patients navigate necessary lifestyle changes -- the same changes we recite at the end of each office visit, often just as the patient is leaving. Yet physicians, healthcare organizations and EMR vendors almost universally reject the very idea of incorporating this data -- let alone the notion of letting their patients contribute directly into the same EMRs providers spend hours pecking information into.
Illustration by Jason Lee
Most physicians detest the volume of strokes and clicks required by EHRs and scoff at the very idea that these systems could actually help them reduce their workload. But ironically, these same physicians are also very reluctant to provide appropriate access to medical records, and are even more skeptical of letting patients directly enter information into their medical records.
Providers cough up numerous reasons to explain why they don't want patients contributing the data needed to improve health care, but they all boil down to one: It doesn't pay.
We, as a nation, have chosen not to pay for healthcare, but we handsomely reward disease care. The resulting fee-for-service system penalizes efficiency and rewards work.
The healthcare industry isn't ready for innovation. Unlike most other industries, which are leveraging technology by pushing as much transaction processing to the consumer, healthcare insists on doing all of the heavy lifting. Healthcare is happy to surf on the back rather than the front side of the technology wave.
Physicians and healthcare bureaucracy are slaves to the fee-for-service model and the related work Relative Value Unit (wRVU) used to calculate physician productivity. RVUs are not awarded to managing devices, apps or patient-generated data. Very few organizations leverage reimbursable telemedicine consults or apply them to patient data management. A face-to-face visit is simply too lucrative compared to a virtual visit.
Further, the typical 8 x 10 jail-cell-style exam room is not designed for the collaborative communication required for optimum care and leads to a cattle call approach to patient care.
This same system also discourages time spent developing relationships with patients. It is heavily weighted against the cognitive effort required to help patients attain optimum health and favors doing procedural tasks that haven't really been shown to improve a patient's health. Our entire "healthcare" industry is, in fact, focused on "disease care." For the most part, the third-party payers -- including the government -- will not reimburse healthcare providers for health promotion or optimization in the absence of a disease.
Because many physicians are competitive, they can be easy prey to administrative and peer pressure that exalts big RVU numbers -- it's not unusual for physicians to reference their RVU production in conversions. Accordingly, administrators disparage activity that does not produce an RVU as "wasted time." In fact, they base the majority of incentives on this definition of productivity. This leads to exhaustion, dissatisfaction and burnout for physicians, along with a total lack of interest in the very tools that have the most potential to affect real change in their own patients' health and in the burden of disease nationwide.
One striking irony in all this is many physicians are themselves proudly wearing these devices and using apps to improve their own health. A few are even prescribing them to their patients. But the industry as a whole refuses to leverage these advances and seems incapable of breaking out of the claustrophobic exam rooms that confine our doctors as they spin through one patient after another. They will stay there until the reimbursement system changes.