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US cancer care worse due to more paperwork

Susan Mayor San Francisco

US cancer specialists are calling for reform of administrative measures designed to reduce healthcare fraud that have resulted in so much paperwork that patient care is suffering, according to results from a survey presented earlier this week.

The survey of more than 2500 clinical oncologists showed that the amount of time they spend filling out paperwork and documenting patient care has increased more than fourfold over the past 25 years.

The average time spent with patients remained constant over this period, but the doctors taking part in the survey considered that far more of this time is now spent in documenting information judged to be extraneous to the reason for the consultation.

The study, carried out by the American Society of Clinical Oncology, also showed that the time spent carrying out clinical research and teaching medical residents had decreased by nearly half.

The president of the society, Dr Lawrence Einhorn, warned the annual meeting, held this week in San Francisco, California: "For years, anecdotal evidence has indicated that the increasing documentation now required takes considerable time away from physicians’ other more important responsibilities. The results of the survey confirm this."

Requirements that increased documentation were introduced by the Health Care Financing Administration as part of an effort by the federal government to stop fraud and abuse within the Medicare system (health care for elderly people).

Dr Einhorn acknowledged the need for safeguards to ensure that healthcare resources were used properly, but he suggested that the level and degree of documentation now required was so excessive that it is damaging the quality of patient care.

Under administration guidelines, for example, doctors are often required to carry out unnecessary diagnostic checks (such as eyes, ears, nose, and throat) and repeat previously asked questions (medical history) to justify billing for the level of service provided.

"Each time a doctor sees a patient, the visit must be documented in painstaking detail," he said. "A patient’s diagnosis and treatment—not checklists published by the government—should drive documentation."

Although the regulations were designed to cover only patients in the Medicare scheme, most hospitals have applied them to all patients. Dr Einhorn warned: "While the purpose of documentation is purportedly to save taxpayers’ money, the true costs of this regulatory burden are being shouldered by society. Patients are receiving less quality attention, medical residents are not getting the individualised instruction they need, and clinical research is suffering."

He reported that the measures have made provision of care to poor patients much more difficult than in the past. "This is not the way to practice humane medicine," he argued.

The American Society of Clinical Oncology now plans to collect more information by visiting several cancer institutions—to add to information gathered at previous visits—before presenting recommendations on how to improve the system to government later this year.
 
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