Patient Care Outside of Office Visits: A Primary Care Physician Time Study

Abstract

Though time spent on AOVs is generally not reimbursed, primary care general internists spent significant time performing AOVs, much of which they perceived to substitute for visits that would otherwise have occurred. Policies supporting physician and staff time spent on AOVs may reduce health care costs, save time for patients and physicians, and improve care coordination.

Prioritizing Paperwork Over Patient Care: Why Can't We Do Both?

“…1 For every 3 minutes spent face-to-face with a patient, 1 minute is needed for clerical tasks, with charting comprising the brunt of this work. 3,[12][13][14] These data are corroborated by a meta-analysis from 2010 that reported only 23% of a hospitalist's time is spent directly interacting with patients. 15 One would think that advances in technology 16 might reduce time committed to clinical documentation due to streamlining of data through an electronic health record (EHR); however, residents and attending physicians may be spending up to 3 times longer with the EHR than when they were using paper charting.…”

Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

“…1,20 The U.S. decline may be due to numerous factors, including the dramatic growth in the number of specialists, health plans that enable direct access to specialty care for common conditions, specialist-oriented medical centers, and insufficient support of and payment for practices to comprehensively manage the expanding population of patients with comorbidities. 1,[21][22][23][24][25][26][27][28][29][30][31][32] In addition, patient-centered medical home (PCMH) 33,34 standards include other primary care features, such as accessibility and coordination, 35-38 but underemphasize comprehensiveness. 39,40 Some include a one-time health risk assessment and reminders about individual services for Bindividual conditions.^Although some PCMH recognition tools include care management plans that begin to address the notion of comprehensiveness, they seldom highlight the scope of services offered and the extent to which conditions and comorbidities are managed by the primary care practice.…”

Defining Team Effort Involved in Patient Care from the Primary Care Physician’s Perspective

“…16,17 In particular, RVUbased reimbursement approaches capture only the effort related to face-to-face patient encounters. 18 Given that a substantial and increasing proportion of primary care work occurs outside of office visits, [19][20][21] new measures of effort also need to capture non-visit-based work. Patient-level factors also contribute to primary care team effort, but these factors are often difficult to identify from existing data sources.…”