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Published on: August 1, 2019
Physicians in ACOs report greater documentation burden
Nate C Apathy1, Vaishali Patel, Tricia Lee Rolle
1University of Maryland, 4200 Valley Dr, College Park, MD 20742.
Insights
Physicians in value-based payment (VBP) programs, especially Accountable Care Organizations (ACOs), face increased after-hours documentation time. This documentation burden is linked to quality reporting and risk adjustment requirements, not necessarily relaxed reimbursement rules.
Area of Science:
- Health Services Research
- Medical Informatics
- Healthcare Policy
Background:
- Value-based payment (VBP) models aim to improve healthcare quality and reduce costs.
- Physician documentation burden, particularly related to electronic health records (EHRs), is a growing concern.
- Understanding the impact of VBP participation on physician workload is crucial for successful healthcare reform.
Purpose of the Study:
- To analyze the relationship between value-based payment (VBP) program participation and documentation burden among office-based physicians.
- To examine how specific VBP programs, such as Accountable Care Organizations (ACOs), influence EHR documentation burden.
Main Methods:
- Retrospective analysis using cross-sectional data from the National Electronic Health Records Survey (2019 and 2021).
- Ordinary least squares regression models were employed to assess the association between VBP participation and EHR documentation burden.
- Program-specific analyses were conducted to differentiate the impact of various VBP models.
Main Results:
- Participation in any VBP program was associated with a 10.5% increased probability of reporting over one hour of after-hours documentation daily.
- Accountable Care Organization (ACO) participation significantly drove this aggregate relationship, leading to an estimated 18 additional minutes of after-hours documentation daily.
- ACO participants reported increased difficulty documenting and a higher likelihood of spending time on inappropriate documentation tasks.
Conclusions:
- Office-based physicians in ACOs experience a greater documentation burden across multiple metrics.
- While some ACOs may reduce documentation for reimbursement, requirements for quality reporting and risk adjustment can increase overall burden.
- The cumulative effect of multiple VBP programs and payers may exacerbate documentation workload for physicians.
Objectives:
First, to analyze the relationship between value-based payment (VBP) program participation and documentation burden among office-based physicians. Second, to analyze the relationship between specific VBP programs (eg, accountable care organizations [ACOs]) and documentation burden.
Study Design:
Retrospective analyses of US office-based physicians in 2019 and 2021.
Methods:
We used cross-sectional data from the National Electronic Health Records Survey to measure VBP program participation and our outcomes of reported electronic health record (EHR) documentation burden. We used ordinary least squares regression models adjusting for physician and practice characteristics to estimate the relationship between participation in any VBP program and EHR burden outcomes. We also estimated the relationship between participation in 6 distinct VBP programs and our outcomes to decompose the aggregate relationship into program-specific estimates.
Results:
In adjusted analyses, participation in any VBP program was associated with 10.5% greater probability of reporting more than 1 hour per day of after-hours documentation time (P = .01), which corresponded to an estimated additional 11 minutes per day (P = .03). Program-specific estimates illustrated that ACO participation drove the aggregate relationship, with ACO participants reporting greater after-hours documentation time (18 additional minutes per day; P < .001), more difficulty documenting (30.6% more likely; P < .001), and more inappropriateness of time spent documenting (21.7% more likely; P < .001).
Conclusions:
Office-based physicians participating in ACOs report greater documentation burden across several measures; the same is not true for other VBP programs. Although many ACOs relax documentation requirements for reimbursement, documentation for quality reporting and risk adjustment may lead to a net increase in burden, especially for physicians exposed to numerous programs and payers.
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