Quality Care Reporting Costs are High

You hear much about the ideals of improving quality patient care.  As the process moves forward, it struggles with the issues of standard rules, the interpretation, and the delivery and results of the data, not to mention the high costs for providers to try to make it work.  The penalties are in place as well, with the underlying threat of lower or no payment for services.

The push for value-based care continues to create problems for physicians. Insurers (with Medicare in the vanguard and passage of the Reauthorization Act in 2015) were designed to speed up value-based payments. The goal is to get physicians to report care results and tie them to payments.

Recently, Health Affairs published a story in the March issue about a study done on the costs of trying to get the reporting and provide the information to insurers. The authors randomly selected 1000 practices from MGMA membership and had them fill out a survey. They represented 4 specialties, cardiology, orthopedics, primary care, and multispecialties. The results show the staff averaged 15.1 hours per week per physician on quality measures. The costs were calculated at $40,069 per physician per year which translates to $15.4 billion spent on just that element of practice. The time burden in terms of even understanding the measures, then trying to provide the data, then interpret the reports from payers has not yet even been quantified.

In theory, the goal is worthy, but the system thus far is clearly not efficient and the rules keep changing. One of the main problems is the lack of standardization of the criteria to be used for determining and reporting the quality care process and outcome. Things like mammography rates or hemoglobin A1c levels are interpreted differently by various insurers.

With the clearly overwhelming failure of EMRs to provide solutions and reliable information mainly because of the lack of any basic standards, quality reporting issues are falling into the same big chasm of more confusion, more overhead, and ultimately really affect quality care in a negative way. Time spent on relatively fruitless tasks takes away time spent with patients.

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