The EHR Click Burden: Documenting Patient Complexity
A physician describes the tedious process of verifying Hierarchical Condition Category codes in electronic health records, which are used to adjust Medicare payments based on patient severity. The article highlights the extra steps required at the end of each visit, often involving deep chart reviews for obscure conditions. It questions whether technology could simplify this documentation and reimbursement workflow.
The HCC verification process adds a distinct layer to end-of-visit documentation. These codes, originally entered by specialists, persist in the patient's record and require primary care physicians to confirm their ongoing relevance. The system presents options to add, defer, or resolve each condition, but determining the correct action often demands a thorough chart review for conditions the physician may not actively manage.
The financial stakes are tied to risk-based reimbursement models. Under accountable care organizations for Medicare-attributed patients, a portion of shared savings bonuses depends on how frequently these codes are added. This creates an incentive structure where documentation thoroughness directly influences compensation, even for conditions treated elsewhere.
This documentation burden could disproportionately affect primary care physicians, who already face significant administrative demands. The time spent verifying codes may reduce time available for patient care, potentially impacting quality. Patients may be indirectly affected if their physicians' compensation depends on coding accuracy rather than clinical outcomes. The system could also create disparities between practices with dedicated coding support and those without, potentially influencing where physicians choose to practice.