Does Oversight Negatively Affect Patient Care?

T-Bone Burnett is a legend in the music business. The award-winning producer has worked with artists ranging from Bob Dylan to Greg Allman to Alison Krauss and Robert Plant. In film, his expertise can be heard on soundtracks for True Detective, Crazy Heart, and O Brother, Where Art Thou?

In a recent interview, he revealed one of the secrets to his success: “Find the best people to do the job, and stay out of their way.”

Throughout life, most of us have experienced the pain of an overbearing boss, a nagging parent, or the occasional backseat driver. The sensation is familiar; we tense up at the sound of their voice and our ability to execute the task at hand -- whatever it might be -- is hindered.

Simply put, we perform best without the constraints and pressures from external forces.

Physicians are no different and, in their cases, it is the payers -- insurance carriers and governments -- who are peering over their shoulders.

Regardless of whether it’s a fee-for-service arrangement or some version of the newly en vogue value-based model, payer oversight persists. According to the New England Journal of Medicine, primary care physicians must comply with over 2,500 performance-based metrics to be eligible for payment.

The American College of Physicians analyzed the appropriateness of these metrics and concluded that only 37% were valid.

In the age of the Electronic Health Record (EHR), this oversight means that physicians spend 2 hours doing computer work for every hour spent with patients.

Is it any wonder that the average primary care visit lasts 15 minutes and patients speak more favorably of their cable provider than their health plan?

No.