Documenting quantity of care rather than quality

Pneumonia shot? Check. Flu shot? Got it.

What do asking about these two immunizations mean in a neurology history? Absolutely nothing, for most cases.

But that doesn’t stop me and other neurologists from asking about them. Why? Because they’re part of the Physician Quality Reporting System (PQRS) measures, of course! None of us want to be penalized by Medicare for failing to document them. Along with medications (Measure 130: drug, dose, and route of administration), counseling for women of childbearing potential with epilepsy (Measure 268), tobacco status (Measure 226), and blood pressure at visit (Measure 317).

My colleagues in orthopedics tell me they’re now documenting a female patient’s most recent mammogram for the same reasons. While it’s unlikely to affect why they need a new knee, it’s what they have to do to avoid penalties.

How much time does this take? About 30-60 seconds per Medicare patient in my practice. That’s not a huge amount of time, but when you see about 1,000 Medicare visits per year, that adds up to 8-16 hours spent on extraneous documentation.

Do I do it to improve patient care? No. Checking off boxes that have no relation to the case at hand makes no difference at all. I doubt you’ll find a practicing physician who believes otherwise. It simply comes down to playing by the rules, no matter how irrelevant they are.

That’s part of the problem in health care today. In documentation, quantity has replaced quality as a measure of care. The concise, pointed, summary has been eclipsed by long notes that document a large amount of unimportant data. Attaching the PQRS data (a 2-page form in my office) to the bill I submit, and noting it in my chart, only wastes time and paper.

Obviously, documenting blood pressure, tobacco status, and medications are important ... but I’ve always done those. I don’t know any neurologist who doesn’t check those things regularly, since they can directly affect our care.

But the rest is just fluff, which, sadly, seems to be more important these days than actually doing something to help the patient, at least in the eyes of Medicare.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Pneumonia shot? Check. Flu shot? Got it.

What do asking about these two immunizations mean in a neurology history? Absolutely nothing, for most cases.

But that doesn’t stop me and other neurologists from asking about them. Why? Because they’re part of the Physician Quality Reporting System (PQRS) measures, of course! None of us want to be penalized by Medicare for failing to document them. Along with medications (Measure 130: drug, dose, and route of administration), counseling for women of childbearing potential with epilepsy (Measure 268), tobacco status (Measure 226), and blood pressure at visit (Measure 317).

My colleagues in orthopedics tell me they’re now documenting a female patient’s most recent mammogram for the same reasons. While it’s unlikely to affect why they need a new knee, it’s what they have to do to avoid penalties.

How much time does this take? About 30-60 seconds per Medicare patient in my practice. That’s not a huge amount of time, but when you see about 1,000 Medicare visits per year, that adds up to 8-16 hours spent on extraneous documentation.

Do I do it to improve patient care? No. Checking off boxes that have no relation to the case at hand makes no difference at all. I doubt you’ll find a practicing physician who believes otherwise. It simply comes down to playing by the rules, no matter how irrelevant they are.

That’s part of the problem in health care today. In documentation, quantity has replaced quality as a measure of care. The concise, pointed, summary has been eclipsed by long notes that document a large amount of unimportant data. Attaching the PQRS data (a 2-page form in my office) to the bill I submit, and noting it in my chart, only wastes time and paper.

Obviously, documenting blood pressure, tobacco status, and medications are important ... but I’ve always done those. I don’t know any neurologist who doesn’t check those things regularly, since they can directly affect our care.

But the rest is just fluff, which, sadly, seems to be more important these days than actually doing something to help the patient, at least in the eyes of Medicare.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Pneumonia shot? Check. Flu shot? Got it.

What do asking about these two immunizations mean in a neurology history? Absolutely nothing, for most cases.

But that doesn’t stop me and other neurologists from asking about them. Why? Because they’re part of the Physician Quality Reporting System (PQRS) measures, of course! None of us want to be penalized by Medicare for failing to document them. Along with medications (Measure 130: drug, dose, and route of administration), counseling for women of childbearing potential with epilepsy (Measure 268), tobacco status (Measure 226), and blood pressure at visit (Measure 317).

My colleagues in orthopedics tell me they’re now documenting a female patient’s most recent mammogram for the same reasons. While it’s unlikely to affect why they need a new knee, it’s what they have to do to avoid penalties.

How much time does this take? About 30-60 seconds per Medicare patient in my practice. That’s not a huge amount of time, but when you see about 1,000 Medicare visits per year, that adds up to 8-16 hours spent on extraneous documentation.

Do I do it to improve patient care? No. Checking off boxes that have no relation to the case at hand makes no difference at all. I doubt you’ll find a practicing physician who believes otherwise. It simply comes down to playing by the rules, no matter how irrelevant they are.

That’s part of the problem in health care today. In documentation, quantity has replaced quality as a measure of care. The concise, pointed, summary has been eclipsed by long notes that document a large amount of unimportant data. Attaching the PQRS data (a 2-page form in my office) to the bill I submit, and noting it in my chart, only wastes time and paper.

Obviously, documenting blood pressure, tobacco status, and medications are important ... but I’ve always done those. I don’t know any neurologist who doesn’t check those things regularly, since they can directly affect our care.

But the rest is just fluff, which, sadly, seems to be more important these days than actually doing something to help the patient, at least in the eyes of Medicare.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.