Because the Medicare and Medicaid patients who incur the highest costs are those with multiple chronic diseases, documentation, coding and billing rules should encourage better care for these patients than they currently do, according to the study, "The Correlation of Family Physician Work With Submitted Codes and Fees" by Richard Young, MD, and Tiffany L. Overton, MPH, published in the American Journal of Managed Care.
On average, the amount of time per visit observed in the study was 20 minutes, including the time required for documentation. The average fees collected for 10-, 20- and 40-minute visits were $84, $102 and $135, respectively, according to the study. These appointment times were consistent with patients with multiple chronic diseases, despite the fact that these patients have more issues to discuss with physicians than average patients.
Dr. Young, the lead author of the study, observed 127 patient clinic encounters of 15 family physicians, which represented a variety of practice locations, practice types and payers. Linear regression was used to assess for associations between the recorded times of each patient's visit with a physician and collected fees.
According to the study, previous research has found that for a middle-aged insured population, family physicians address 2.5 to 3.1 chronic issues in the average clinic visit, and the average amount of chronic issues per visit grows to 3.9 to 6 for elderly patients and to 4.6 for patients with diabetes. However, primary care physicians in clinics only spend one minute on additional patient concerns after the main complaint is addressed, which the researchers say could lead to inadequate care for common chronic conditions.
The pressure to end one patient's visit to begin the next has been associated with reduced provisions of care for common chronic diseases when other patient concerns are addressed during the appointment, according to the study. The time pressure physicians often experience has also been associated with decreased job satisfaction, unfavorable workflow, high stress and increased burnout.
In contrast, the study shows longer consultations in primary care have been found to improve processes of healthcare and are associated with greater patient satisfaction and lower healthcare utilization. Less thorough medical histories, lower rates of preventive services, lower patient satisfaction and unfavorable physician-patient relationships commonly result from shorter family medicine visits, according to the study.