Bringing Value to the Medicare Physician Schedule: 25 Years of the - - PowerPoint PPT Presentation

Bringing Value to the Medicare Physician Schedule:

25 Years of the Resource Based Relative Value Scale

Ming Tai-Seale, PhD, MPH Associate Director Sutter Health Palo Alto Medical Foundation Research Institute

Background

• Physician effort is a crucial resource
• Agent’s work effort is often viewed as unobservable
• Previous/ongoing efforts to study MD work
• Resource Based Relative Value Scale1
• National Ambulatory Medical Care Survey2
• Time Allocation in Primary Care Office Visits3
• What’s keeping physicians busy4
• Aim:
• To describe how individual PCPs allocate time on different ambulatory care

activities,

• by reviewing “access logs” (i.e., stamps) generated by an EHR

1Hsiao et al 1988 JAMA; 2Mechanic et al 2001 NEJM; 3Tai-Seale et al HSR 2007; 4Baron 2010 NEJM

EHR Access Log 471 PCPs 765,129/ 637,769 PTs IM, FM, & PED 4 years (2011-2014)

31,002,888 Time Blocks

What Does the Log Capture?

Discrete, time-stamped actions associated with patient care, by:

User Begin/End Time Device Patient

An Illustrative Work Day

Mean S.D. Median 90th percentile Number of F2F Visits/day/MD 13.5 6.2 13 21

Tai-Seale et al, April 2017, Health Affairs.

1 2 3 4 5 6 7 Geriatric Medicine Radiology Dermatology Obstetrics/Gynecology Pediatrics Internal Medicine Family Medicine Face-to-face Progress note Telephone encounters Secure messages Prescription refills Other

InBasket Messages/Week

50 100 150 200 250 300 350 400 450 Other Non-procedural Specialties Other Procedural Specialties Shift/Non-Scheduled Specialties OBGYN PEDS FM IM

Mean Msg/week

Mean Msg/week

Volume 3 Chapter 8 Physician Management of Demand at the Point of Care M Tai-Seale 2014

Implications

Monitoring Incentives Leverage Access Log Data