WHA Physician Leaders Council Discusses EHR Workload; Psychiatrist Reimbursement Advocacy

December 08, 2017

The WHA Physician Leaders Council met December 5 and discussed a range of topics impacting physicians and physician practice within WHA’s member hospitals and health systems, including:

  • WHA 2018 advocacy and education re: physician EHR time
  • Medicaid outpatient behavioral health reimbursement
  • APRN Modernization Bill
  • WHA Physician Quality Academy
  • WHA Physician Leadership Development Conference
  • Constitutionality of medical malpractice non-economic damage cap
  • 2018 MACRA/QPP changes

Advocacy and education on EHR-related physician workload

As an outcome of the October Council discussion on the UW family practice study on physician electronic health record (EHR) time burdens, the Council discussed potential WHA advocacy and educational strategies that it could advance in 2018 to address EHR-related physician workload burden. 

“While enabling ‘top-of-license practice’ has traditionally been a concept we talk about for advanced practice clinicians, it is as important if not more important that we ensure physicians are able to practice at their ‘top-of-license,’” said Steve Kulick, MD, chair of the WHA Physician Leaders Council and chief medical officer for ProHealth Care. 

In October, the Council reviewed and discussed the UW Family Practice study, “Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time Motion Observations,” which appeared in the September/October 2017 Annals of Family Medicine. That study quantified the time family practice physicians spent on documentation and interactions with the EHR during and after the work day (see story).

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, and noted that a number of physicians had reduced their clinical FTE to less than full time due to workload.

Continuing to expand WHA’s regulatory relief and reform advocacy to address regulatory burden directly affecting physicians was a key part of WHA’s integrated physician strategic guidance document adopted by the WHA Board in October. 

“Regulatory burden not only personally impacts physicians and contributes to dissatisfaction, but also impacts the efficiency of health care delivery overall,” said Eric Borgerding, WHA president/CEO.  “Addressing that regulatory burden on physicians will be a key focus for WHA as it develops its next five-year strategic plan in 2018.”

WHA advocacy on Medicaid outpatient behavioral health reimbursement for psychiatrists

WHA staff discussed recent WHA advocacy on implementation of the recently announced Medicaid reimbursement increase for outpatient behavioral health services. See November 22 WHA Valued Voice article.

In written comments WHA provided to the Department of Health Services (DHS) in November, WHA thanked the Governor and DHS for this important investment of $7 million in state funds to increase Medicaid reimbursement rates for professionals providing outpatient mental health and substance use disorder services.

However, as DHS implements that increase, WHA urged DHS to include evaluation and management (E/M) billing codes for psychiatrists, APNP-psych and psychiatric physician assistants in the list of procedure codes that will receive a reimbursement increase. 

In October, WHA identified a concern that the E/M reimbursement codes utilized by psychiatrists are not located within the section of billing codes traditionally viewed as behavioral health codes. According to feedback provided to WHA by its members, E/M billing codes make up at least 80 percent of psychiatrists’ outpatient visits for Medicaid patients.

WHA also expressed concern about a draft implementation proposal that would pay physicians specializing in psychiatry, APNP-psych, and psychiatric physician assistants at the same rates as other behavioral health providers without prescriptive authority and lesser education and training requirements. Currently, psychiatrists, APNP-psych, and psychiatric physician assistants receive a higher reimbursement than non-prescribing psychotherapists.

APRN Modernization Bill

The Council discussed and provided input on the recently introduced APRN Modernization Bill and WHA’s advocacy to improve the bill. The Council discussed many of the same issues discussed by the WHA Board December 7.

Collaboration requirements for certified nurse midwives was one particular area of discussion by the Council. The Council agreed WHA should proactively recommend that the collaboration standard for certified nurse midwives that solely deliver babies in a hospital setting should be changed from a “collaborative agreement” standard to the lower “documented collaborative relationship” standard that currently applies to advanced practice nurse prescribers.

With the additional quality assurance and other regulatory structures in place in a hospital setting, moving from a collaborative agreement standard to the lower documented collaborative relationship standard makes a lot of sense for nurse midwives solely delivering in hospitals, explained one of the Council members who is an OB/GYN physician.

WHA physician education opportunities

WHA shared plans for the 2018 WHA Physician Quality Academy and the 2018 WHA Physician Leadership Development Conference. 

Building on the inaugural 2017 WHA Physician Quality Academy, the two-day training session provides the training and resources for physicians and advanced practice providers who have an assigned role or have been asked to lead a project related to quality measurement and improvement within a WHA member organization. To view the agenda and registration, go to: 2018PhysicianQA.pdf.

Chuck Shabino, MD, WHA chief medical officer, also provided an overview of the 2018 WHA Physician Leadership Development Conference scheduled March 9-10 in Kohler. The agenda and registration can be found here: 2018PLD.pdf.

Medical malpractice non-economic damage caps

Matthew Stanford, WHA general counsel, 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. For additional information see the news article.

2018 MACRA/QPP changes

Kelly Court, WHA chief quality officer, and Laura Rose, WHA vice president, policy development, provided an overview of the 2018 Medicare Quality Payment Program (QPP) final rule. They discussed WHA’s advocacy on the proposed rule, and the final participation requirements for 2018 and future years under the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (Advanced APM) pathways created by MACRA. For additional information, see the news article.

This story originally appeared in the December 08, 2017 edition of WHA Newsletter