The Forgotten Physician

Devorah Goldman in National Affairs:

Ronald Dworkin has written in these pages about the evolving identity of the American physician, from gentleman-doctor to benefactor to technician to scientist. In recent years, a combination of new laws and technologies have again redefined the doctor, this time as a sort of data-entry clerk. As Dr. Robert Wachter and health-policy consultant Jeff Goldsmith put it in the Harvard Business Review, “Only in health care, it seems, could we find a way to ‘automate’ that ended up adding staff and costs!” A taste of what today’s doctors must contend with can be found on the “Official Website of the Office of the National Coordinator for Health Information Technology,” one of several government sites devoted to explaining Medicare to physicians:

Regardless of whether you’re reporting on the Advancing Care Information Objectives and Measures, or on the Advancing Care Information Transition Objectives and Measures, using certified [Medicare Electronic Health Records (EHR)] technology can aid you in the process. It may help you attain the 25 points allocated to Advancing Care Information reporting as part of the [Merit-based Incentive Payment System (MIPS)] program….Using a certified EHR technology is required for reporting Advancing Care Information measures for most clinicians…and it may make your overall MIPS reporting easier.

The jargon-laden instructions go on to provide links to several different webpages that discuss exceptions to these rules, explain the various technologies mentioned, and go into greater detail about MIPS itself. These do not include CMS’s many instructions for Medicare reporting and compensation, which can be found on the CMS website, or those provided on, which is separate from Given the complexity of reporting requirements, it isn’t surprising that physicians have begun to hire medical scribes, additional administrators, or consultants specially trained in “health IT” to navigate Medicare’s reimbursement system. The costs of these newly created positions are not covered by Medicare: Doctors must pay for the services out of pocket or spend their working hours taking endless notes and filling out forms instead of caring for patients. One large-scale survey in 2016 found that, of 17,236 physicians who responded, only 14% said “they had the time they needed to provide the highest standards of care.”

More here.