From: Reuters
Published November 26, 2007 04:44 PM

Elder care outside the office often provided free

NEW YORK (Reuters Health) - Geriatricians spend a significant amount of uncompensated time outside of office visits providing care for chronically ill patients, study findings suggest.

"Primary care is becoming increasingly focused on the management of chronic disease in a health care system that is more suited for episodic care of an acute illness," Dr. Jeffrey Farber and associates note in a report published this month. As a result, much of that care is provided outside of regular office visits.

To gauge the extent of unreimbursed care, Farber, at the Mount Sinai School of Medicine in New York, and associates asked 16 doctors in a geriatrics practice to record all clinical encounters that occurred outside of office visits. Their analysis included 472 discrete interactions involving 226 patients. Most patients had some form of cardiovascular disease and nearly half had dementia.

For each 30-minute office visit, the doctors spent an average of 6.7 minutes providing additional care. This translated to an extra 7.8 hours of work per week for a physician who sees 14 patients per day, 5 days a week.


Half of the extra interactions were with patients or family members, while the remaining 50 percent involved other physicians and support staff.

In a written commentary, Dr. Thomas Bodenheimer calls these results "striking," suggesting that they at least partially explain failures to provide adequate coordination of care among Medicare beneficiaries.

Bodenheimer, from San Francisco General Hospital in California, estimates that only 30 percent of between-visit interactions could be delegated to office staff. In Farber's study, the majority of interactions involved new symptoms, discussions with other professionals, family counseling or managing chronic problems, "clearly physician-level duties."

"If physicians are to improve their care coordination performance, they need time to do the work and must be paid for the work," Bodenheimer concludes.

SOURCE: Annals of Internal Medicine, November 20, 2007.

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