Physicians in ACOs report greater documentation burden.

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.