Focus on productivity by health care systems affects quality of care
I’m sure you’ve heard the term “productivity” and know that increased productivity is a goal in most, if not all, businesses. But, did you know that increased productivity is also now expected – and demanded - of our doctors. And it’s not patients who are doing the demanding, it’s physician’s employers (typically the large health care systems you see being advertised everywhere these days).
Why are health care systems focused on increasing doctor’s productivity, which they define as the number of patients a doctor sees each day? Simple: Money and Profits!
Here’s how it works. Productivity (the number of patients seen each day by each doctor) is combined with RVUs (“Relative Value Units” which are assigned to the care and procedures doctors provide) and Throughput (which is how quickly patient encounters occur - the faster the “Throughput”, the more patients the doctor can see). Increased productivity (from faster Throughput) means more RVUs, and more RVUs translate to more revenue to the health care system. As one health care system put it, “Producing even 2.5% more RVUs, would result in an additional $6.3 million in revenue.”
But, increased productivity is not good for patient care!
To increase Throughput and Productivity, health care systems impose various policies and practices including, for example:
Double or triple booking patient visits (i.e., scheduling two or three patients for each appointment slot – which explains why you end up waiting even if you have the doctor’s first appointment slot of the day)
Shortening the length of each visit (from 30 to 15 minutes or 20 to 10 minutes)
Spreading out patient’s follow-up visits (e.g., allowing doctors to see chronically ill patients only every six months rather than every two or three months).
None of these practices are good for patient care, and it’s not how doctors want to practice medicine. It’s how the health care systems demand that they practice medicine.