Ben Franklin told a young tradesman, “Time is money.” In an age of distraction, everything takes time. Economists call it opportunity cost. Do you stay out late after dinner, or prepare for the next day? Is an eMBA worth the effort?
Successful businesses know that new work costs money. Either old tasks go undone, or you hire staff to tackle new projects. Corporations go broke if they don’t pay close attention to how workers spend time on the job.
Stealing Millions from Patient Care – One example
Our team received a final notice from our site admin. Every physician must complete a survey, or we lose funding for our electronic medical record (EMR). The survey had close to 100 questions and took 2 hours to read carefully and answer accurately.
[Full disclosure: I love EMRs, IT and clinical tools of all sorts. I think we need more informatics, not less.]
Over 11,000 Ontario physicians on EMR x 2 hours = 22,000 hours of clinical time spent on 1 survey.
= 9.6 years (22,000 / (50 hours per week x 46 weeks per year)).
= $3.252 million for 1 survey [9.6 years x $340,000 (average gross billings)]
Of course, time spent away from clinical care saves the government money. Docs get dozens of similar non-clinical requests.
Administrative Off-Load
Efficient hospital-based medical groups remain on high alert to admin off-load. Hospital administrators love to build arguments for why a specific administrative task requires an MD (e.g. RM&R forms for community nursing, Transfer forms for mental health patients).
It saves hospitals money. If they can convince docs to do something, it means they don’t have to hire staff using hospital funds. MDs get paid from OHIP, not hospitals.
Laziness and Efficiency
Vice often drives virtue. Laziness makes us to look for easier ways to work. My Scottish Granny might have harrumphed, “You find shortcuts so you can do MORE work, not less!”
Ok. But we still don’t spend our time looking for ways to make work harder. Unless you’re a bureaucrat. Bureaucracy slows things down, resists change, ‘manages’ innovation.
Bizzaro World
In nationalized services, governments save money by slowing down their most expensive assets. They save by shutting down MRIs, closing operating rooms and shackling physicians with as much non-clinical work as possible. Up is down and down is up in Bizzaro world.
$3.25 million dollars of potential patient care wasted on one survey is only a shaving off a lumber pile of waste. If politicians were serious about efficiency, they would insist on freeing up doctors so patients could receive more care.
But more care costs money; who wants that?
photo credit: currencyguide.eu
Great post – as usual. A shame that the gov’t through their abysmal mismanagement is letting bureaucracy – and you have only addressed a small part of it here – destroy our health care system. I am really coming to think that it is one of the biggest elements that needs a huge overhaul in order to have any hope of saving the health care system. Drs might not mind the occasional (reasonable) survey if the gov’t actually paid attention to the responses.
Thanks for reading and commenting, Valerie!
I think government lets bureaucracy and legislation metastasize because they’re the only tools government has. They can’t use competition, quality, service, efficiency, productivity, price, innovation or any of the other standard levers of change used in non-nationalized services.
Thanks again for taking time to share!
Best
Shawn
Suspect EMR funding will be cut at some point anyway as CPSO is moving toward making having an EMR ‘the standard of care’. Already the stipend has been significantly reduced with more requirements to meet to get that reduced stipend.
Does not take a rocket scientist to see where this, like everything else with Ontario physicians, is going. The tried and true formula goes like this…entice the docs to do something with money (EMR, captivated models), then reduce or take the money away later when enough of the targeted docs have been snared while making the requirements more onerous.
Thanks Paul.
It’s pretty hard to disagree with your observation. We let FFS die in the early 2000s leaving the A007 flat-lined or declining. Now capitated models have been decapitated, and FFS isn’t there to fall back on.
In the USA, billing per unit of work based on the medical record was in force decades ago. EMR makes it easier to ‘measure’ units of ‘work’. In reality, it measures units of tick-boxing, not clinical care. We must not delude ourselves into thinking that patients get more and better care with a long, pretty clinical note compared with “Dx: AOM. Rx: Amox”. In fact, patients might have felt more cared for and enjoyed better outcomes when physicians spent most of their time with patients instead of clinical records.
Having said that, I like EMR. It appeals to my sense of order and efficiency. Used well, it speeds me up; makes me a better doc.
Thanks again for sharing your thoughts!
Best
Shawn