Monday, June 15, 2015

Words, words, mouthy, mouthy

Although electronic notes have helped legibility, they have also led to the creation of voluminous notes that regurgitate data ad nauseam yet add little to medical understanding or patient care. Frequently, a seven-page consultant note can be distilled down to one-and-a-half lines of italicized print, entered by the consultant, in the last half-page of the note....

The explicit reason for the length of consult note is that the Centers for Medicare & Medicaid Services (CMS) and other payers peg their assessment of the amount of work done, and hence the valuation of the physician's work, to detailed, elemental narration of the history of present illness, medical and surgical history, review of systems, and examination. It remains beyond the capabilities of payers to truly understand the nuances of risk assessment and complexity of decision-making involved in patient care. Consequently, they reward the effort of dictation over the effort of abstraction. They reward the mechanics of the key logger over the mechanics of the thinking mind...

Ideally, a consultant's note should be concise as it addresses the issues of patient care. It should be brief and not duplicative, logically structured, and of educational value. Such a note is an effective note. It is not one that is "optimally reimbursed" by today's payers...

Done correctly, a consultant's note can challenge both the requesting and the providing physicians (or nonphysicians) to think more fully and broadly, improve patient care and outcomes, and reduce unnecessary testing or treatment while also being educational. Unless and until payers recognize that it isn't the length of the consult that matters as much as how the consult is created and used, the system as a whole and both patients and providers will continue to suffer.

The reality is that insurers also suffer under the current system. After all, they are paying for volumes of lower-quality information, much of which may be only cursorily reviewed, if not left unread.


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