Physician viewpoint: The way out of EHR purgatory? Change the way clinicians are paid

To reduce the administrative burden on clinicians using EHRs, the healthcare industry must shift from fee-for-service to value-based care reimbursement, Allan H. Goroll, MD, an internist at Boston-based Massachusetts General Hospital, wrote in an op-ed for the New England Journal of Medicine.

Clinicians are typically reimbursed under a fee-for-service model supplemented by pay-for-performance metrics, according to Dr. Goroll. This trend has led payers to demand detailed EHR documentation — about both the process and volume of patient care — to justify reimbursement.

"Much to the chagrin of clinicians, the EHR has become a billing instrument that requires excessive process documentation, coding and other activities that are devoid of meaning for patient care," Dr. Goroll wrote.

Under a fully performance-based model, clinicians would not be tethered to EHRs to ensure compensation. Instead, a healthcare facility might be paid upfront based on resources they need to treat the patient, and payment adjustments would be awarded based on patient progress, Dr. Goroll suggested.

"Such an EHR would begin to take on the look and feel of an essential instrument of patient care and population health management rather than a billing statement," Dr. Goroll wrote.

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