comscore Column: How to reduce physician burnout in this time of COVID-19 | Honolulu Star-Advertiser
Editorial | Island Voices

Column: How to reduce physician burnout in this time of COVID-19

  • Tad Iwanuma, M.D., is an internist who has practiced in Honolulu for 46 years plus two years in the Army; he says that interestingly, he is not burnt out.

    Tad Iwanuma, M.D., is an internist who has practiced in Honolulu for 46 years plus two years in the Army; he says that interestingly, he is not burnt out.

In the worst of times we have seen the best care-giving qualities emerge from our physicians and health care professionals. Encumbered by the lack of full knowledge of SARS-CoV-2 pathogenicity, they have endured great danger to care for patients.

They answer their calling despite having to endure counterproductive policies imposed on them by healthcare directors and insurance companies in the name of reform. A slight and insightful reprieve from the current dictates has taken place during the pandemic. The Centers for Medicare and Medicaid Services and insurance companies have responded to this health crisis by loosening regulations, withdrawing monetary penalties and developing new codes.

This reprieve comes at a time when our physician nationally are dealing with physician burnout, a largely unpublicized problem in Hawaii. The National Academy of Medicine reports 35-54% of physicians are burned out.

The disconnect lies in the health care organizations not aligning their goals with those of physicians.

Insurance entities have reformed medicine by altering previous payment methods and quality evaluations. HMSA’s Payment Transformation (PT) is one example. The Atherton Foundation recently funded a study of HMSA’s PT by Aimed Alliance. It reported widespread dissatisfaction among Hawaii’s primary care physicians (PCP) — e.g., pediatricians, family practitioners and internists, due to perceived deficient methodology and low financial compensation.

Payment transformation pays PCPs $24 per patient per month (PPPM) no matter how many office visits a patient makes. Additionally, approximately $4.50 PPPM is at-risk. This portion is determined by physicians reporting numerous metrics over the past and present year via codes inserted into patients’ electronic medical records (EHR) or reported in Coreo, an internet program. Blood pressure measurements, diabetes blood tests results and tobacco usage are examples.

Medical Economics magazine recently reported the average PCP gained two-thirds of metric payments.

Medicare’s Merit-Based Incentive Payment System is another yearly metric-based reporting system. In 2020 the total payment adjustment up or down is 4% and in 2021, 5%. Medical Economics recently reported only 40% of internists participate in the program.

Payment for physician medical services is now based on monetary incentives and penalties to practice the reformers’ ideas of good medicine — the carrot-and-stick approach. Most physicians don’t get the carrot. Many get the stick.

The EHR provided the base for these reporting programs. Numerous new programs were developed, but with a significant downside, an enormous amount of time required to input data.

The Annals of Internal Medicine reported physicians spend 18-22 minutes charting a patient’s medical visit. Medical Economics reported internists spend 18.5 hours per week on administrative tasks. For a PCP who sees 15-20 patients per day, charting and paperwork is chasing infinity.

In 2019 WalletHub found Hawaii had the 48th lowest average annual physician compensation and in 2020 rated Hawaii the 42nd worst state for doctors to practice medicine.

A physician’s competence is now determined by how many boxes are clicked in the EHR and reporting of metrics determined by non-physician health organizations.

Many physicians feel unattached and isolated in our medical system. They have no input. Proper alignment with rule makers, health organizations and health insurers needs reconfiguration.

During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services and other health insurers lifted regulations and penalties and put patients before paperwork. They did not respond with new metrics, incentives and penalties. Physicians feel part of a national team with a shared purpose of dealing with our crisis.

The temporary lifting of regulations offers a glimpse into what could collectively be pursued in the future to free doctors from burnout and bring better medical care to all of us.

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