WHA Physician Leaders Council Discusses EHR Workload; Public Policy

October 06, 2017

The WHA Physician Leaders Council met October 3 and discussed a range of topics impacting physicians and physician practice within WHA’s member hospitals and health systems, including:

  • UW’s study on EHR-related physician workload;
  • WHA activities supporting members’ integrated physician enterprise;
  • Additional GME funding in the state budget;
  • WHA emergency detention reform bill;
  • Team-based care and co-signatures;
  • Worker’s compensation rate setting;
  • Medical malpractice non-economic damage caps; and,
  • Federal ACA repeal/replace and bundled paymen program.

“The WHA Physician Leaders Council is a critical structure to continually advance WHA’s member value-focused agenda,” says Steve Kulick, MD, chair of the WHA Physician Leaders Council and chief medical officer for ProHealth Care. “This Council serves as WHA’s primary resource for informing and guiding WHA decision making on integrated physician advocacy, education efforts and physician leader support.”

UW study on EHR-related physician workload

WHA invited John Beasley, MD, UW College of Engineering, Department of Industrial and Systems Engineering, to present findings and conclusions of a recently published UW Department of Family Medicine and Community Health study on primary care physician workload related to the electronic health record (EHR).

The UW researchers found clinicians spent 5.9 hours of an 11.4-hour workday in the EHR per 1.0 clinical full-time equivalent. The study tracked and measured non-resident UW family practice physician work and interactions with the EHR over a three-year period beginning in 2013.

Documentation, order entry, billing and coding, security and other clerical and administrative tasks accounted for 2.6 hours of the workday, and inbox management accounted for an additional 1.4 hours.  The study also found that 1.4 hours of EHR time occurred outside of 8 a.m. to 6 p.m. clinic hours.

“This study helps to move the conversation within organizations and with policymakers on EHR burden related physician burnout from discussion to actionable quantitative metrics,” said Chuck Shabino, MD, WHA chief medical officer.

“For policymakers, the study also highlights the cumulative effect that regulatory burden has on physicians’ time,” said Matthew Stanford, WHA general counsel. “A physician’s workday is a finite resource, and WHA will continue to work with policymakers to reduce regulatory burdens to help ensure more of that time is spent providing care to patients.”

Building on its 2016 work developing the WHA Physician Engagement and Retention Toolkit, the Council began a discussion of potential next steps and partnerships WHA could undertake to build awareness of this UW study and develop further educational and policy solutions to reduce inefficient physician workload. 

The article, “Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time Motion Observations,” appears in the September/October 2017 Annals of Family Medicine.

WHA activities supporting members’ integrated physician enterprise

The Council continued its dialogue on how WHA can best support its members’ integrated physician enterprise now and in the future. The Council is a key component of WHA’s efforts to continuously define and identify how best WHA can meet its members’ needs in support of their integrated physician enterprise.

“As WHA’s members’ focus has evolved beyond the traditional ‘walls’ of the hospital to a presence as local and regional integrated health systems, WHA’s focus has similarly evolved,” said WHA Chief Medical Officer Chuck Shabino, MD. “The physician component of our members’ enterprise is significantly larger, and WHA has been evolving to respond to those changes by focusing on WHA activities and strategic partnerships to incorporate, from the system prospective, physician issues, opportunities and initiatives.”

State legislative and regulatory updates

Additional graduate medical education (GME) funding in the state budget: One of WHA’s 2017 state budget advocacy priorities was to increase Wisconsin’s investment in the state’s GME matching grant program to help expand access to GME programs in Wisconsin. Leading a coalition of organizations including the Wisconsin Academy of Family Physicians, the Wisconsin Council on Medical Education and Workforce, the UW School of Medicine and Public Health and the Medical College of Wisconsin, WHA budget efforts were successful. The final budget includes $1.5 million in new state funding and preserves $1 million in funding set to lapse to support the state’s GME program.

“Wisconsin’s aging physician workforce and aging patient population is creating challenges for the state’s health care delivery system. Data shows Wisconsin needs between 2,000 and 4,000 additional physicians by 2035,” said Shabino. “We know graduate medical education is a key factor in where physicians end up practicing, and funding GME is a successful model to recruit and retain physicians in Wisconsin.”

Emergency detention reform: Matthew Stanford, WHA general counsel, provided an update on WHA’s long time work to develop and introduce a bill that would clarify a health care provider’s liability in emergency detention situations and that would align Wisconsin’s emergency detention statute with the federal EMTALA law. Stanford said this WHA-led bill introduced this week is the culmination of multiple years of work to address concerns raised to WHA by member organizations’ emergency department physicians that they may have obligations under state and federal law that Wisconsin’s emergency detention law does not permit them to fulfill. 

“Multiple entities are involved in and have a stake in Wisconsin’s emergency detention process,” said Stanford. “Hospitals, physicians, counties and law enforcement each have their own perspectives, authorities and obligations. WHA has engaged members and those stakeholders in multiple years of discussions, proposals and drafts to reach agreed-to bill language that protects physicians and hospitals by better aligning health care providers’ obligations with their authorities under Wisconsin’s emergency detention law.”

Team-based care and co-signatures: Stanford also provided an update on WHA’s ongoing work to remove regulatory barriers to team-based care. In particular, Stanford addressed questions regarding physician co-signatures and WHA’s work with the Department of Health Services to address confusion regarding the need for physician co-signatures of services provided by advance practice providers.

Worker’s Compensation rate setting: Kyle O’Brien, WHA senior vice president, government relations, discussed WHA’s efforts and partnership with the Wisconsin Medical Society and other organizations to push back a proposal to establish government rate setting/fee schedule in the worker’s compensation program. 

Medical malpractice non-economic damage caps: Stanford briefed the Council on the status of the Ascaris Mayo v. IPFCF case challenging the constitutionality of Wisconsin’s $750,000 non-economic damage cap in medical malpractice cases. Stanford discussed WHA’s strategy regarding the challenge to this important bipartisan public policy, including WHA’s close collaboration with the Wisconsin Medical Society on this issue. He said WHA is preparing for Supreme Court briefing in the case around the start of the new year.

Federal ACA Repeal/Replace Update

Joanne Alig, WHA senior vice president, policy and research, provided a report to the Council on the latest developments related to ACA repeal/replace in both Washington, D.C. and Madison, including WHA policy priorities and advocacy strategies. Alig highlighted the inclusion of language in the Graham-Cassidy-Heller-Johnson bill that would include funding formulas to correct the distribution of money under the ACA in order to “reflect the unique circumstances of many states, including recognizing the innovative reforms of Wisconsin.”

Alig and the Council also discussed impacts of the recent changes to the CMS bundled payment program on organizations that had been participating in that program.

This story originally appeared in the October 06, 2017 edition of WHA Newsletter