Physician Time Spent Using the Electronic Health Record During Outpatient Encounters
TO THE EDITOR: Overhage and McCallie (1) reported that primary care physicians and ambulatory medical subspecialists actively used electronic health records (EHRs) for an average of 16 minutes and 14 seconds per patient encounter. Eleven percent of this time was spent after hours. Physicians whose work is primarily cognitive spent the most time actively using EHRs. Adler Milstein's editorial (2) that accompanied Overhage and McCallie's article asks 2 questions: Is this too much time, and how can required clinical information be generated most efficiently? Although answering these questions is critical, an even more immediate question is: When do physicians, especially those in primary care, find the time to provide necessary care and navigate the EHR without burning out (www.ahrq .gov/prevention/clinician/ahrq works/burnout/index.html) A recent analysis of data from the National Ambulatory Medical Care Survey (3) found that in 2015, the average time spent during a primary care visit was 21.6 minutes. The heavy burden that EHR use currently places on physicians' time clearly necessitates more time per encounter and fewer encounters per day. However, primary care physicians who are among the lowest paid in the profession (4) cannot perform fewer patient encounters unless they are paid more per encounter, something that will be accomplished only with an increase in valuation of cognitive services. In the United States, payment levels for medical services are largely based on the Centers for Medicare Medicaid Services' resource based relative value scale. In 2018, the Medicare Payment Advisory Commission, a nonpartisan congressional agency, reiterated its long standing concern that evaluation and management services are underpriced by the Medicare fee schedule compared with other services, such as procedures (5) The Commission concluded that the fee schedule is not well designed to support service delivery for multiple complex chronic conditions requiring extensive care coordination. Although the Centers for Medicare Medicaid Services has increased payment for evaluation and management services since 1992, Medicare payment for a midlevel office visit (CPT [Current Procedural Terminology] code 99213) was $75 in 2019 (www.cms.gov/apps/physician fee schedule/overview.aspx) The Centers for Medicare Medicaid Services must increase valuation of cognitive services in order to accommodate the heavy time demands of EHR use among physicians who provide cognitive services, ensure high quality patient care, prevent physician burnout, and sustain the physician workforce.
Annals of Internal Medicine