Patients are our priority, not paperwork

Regarding Dr. Schuman’s article “MOC controversy: Issues and answers” (Contemp Pediatr. 2015;32(1):34-36): I, too, feel, that [Maintenance of Certification (MOC)] is a costly and meaningless exercise. Many of the projects seem like they are more helpful in providing data to researchers than they are useful to those in the field collecting and reporting the data. I had to frequently clarify what activity counted for which part so I would be certain that I met all the requirements.

Honestly, between MOC and other CME, requirements for computerized records, government and insurance company demands, ICD-10, and [patient-centered medical home], less and less time can be spent on actual patient care. Not only have we lost control of our profession, it is becoming difficult to understand the very reason we went into the profession in the first place. Then I remember the actual patients who benefit from and value the little time I have left in the day to do what I was trained for, and that helps me come back another day.

There is nothing wrong with having some educational requirements, but with all the current demands, we have to revisit how they contribute to the actual quality of care we are providing. Most important, we need to remember that patient care should be our priority.

Carrie Kluger, MD

Via e-mail

Dr. Schuman responds:

Dr. Kluger: Thank you for responding to my article on MOC. I think you hit the nail on the head in expressing that: 1) Many of the MOC requirements (especially Parts 2 and 4) are meaningless because there is no convincing evidence they improve the quality of care provided to our patients; and 2) MOC-related CME and projects take our time away from actual patient care. We both agree that pediatricians are “lifelong learners” and accustomed to completing yearly CME requirements.  

Although most pediatricians would like the American Board of Pediatrics (ABP) to revise the MOC program, it is unlikely this is going to happen anytime soon. The American Academy of Pediatrics (AAP) has remained silent regarding this issue, perhaps because MOC generates substantial revenue for the AAP by supporting AAP-generated CME and MOC projects.

Perhaps it is time that we use our mice and keyboards to request that the AAP recognize that its members need the MOC program revised in both the short and long term. Use this link to contact the AAP Board of Directors: bit.ly/AAP-Board-of-Directors. There is also a website where pediatricians can sign a petition requesting the AAP use its influence to have the ABP institute a moratorium on the MOC program: go to bit.ly/MOC-petition. Although few pediatricians are aware of the online petition, it has nearly 1000 signatures as of this writing.

It is high time that pediatricians join with one another to take back the practice of medicine from the government, insurance companies, and the ABP. If the AAP won’t address this issue, perhaps it’s time to consider forming a new provider advocacy organization that will. Although I’ve used this quotation by Jerry Garcia of the Grateful Dead several times in the past, it seems especially fitting to close with it one more time: "Somebody has to do something, and it's just incredibly pathetic that it has to be us."

For another letter on MOC and Dr. Schuman's response, click to the next page.

A fraud on our profession

Regarding Dr. Schuman's article “Meaningful use 2? Just say no” (Contemp Pediatr, 2014;31(11):41-43): Finally! Somebody writes the truth! I have said from day one this [electronic medical records (EMR)] farce being forced on [our[l profession is nothing more than a way for big brother to watch over what we do and use it an excuse to pay us less. It has never been about improving patient care.

We need not even bother to do Stage 2 as it is too dependent on factors we cannot control (eg, patient input). Take your pay cut and be glad that is all it cost you. 

Our experience with Digichart and Stage 1 was even worse. We did what we thought was the correct process-spent hundreds of thousands of dollars to implement the EMR system and spent most days in frustration. Our reward was, 3 years after the fact, all 5 physicians were randomly audited by the [Centers for Medicare and Medicaid Services (CMS)] and have had roughly $90,000 dollars demanded [as payback], plus penalties and interes. 

Use the system to practice your craft, if you must, but other than that, it is nothing but EFMR-electronic fraudulent medical records. Probably not what some might think the F was for . . . .

Scott Peters, MD

Via e-mail

Dr. Schuman responds: 

Dr. Peters: Thanks for responding to my article on Meaningful Use, Stage 2.  

It is clear you are one of the many providers who are passionate in their dislike of electronic health records (EHRs). In my view, EHRs improve care just by producing legible office notes and keeping medication and problem lists current. Let’s not complicate EHR adoption and use by generating meaningless data for the CMS.

I agree that many EHRs are overpriced, too complicated, and require too much button clicking and data entry just to document a straightforward patient visit. As is too often the case, following EHR adoption office productivity declines and with it office revenue. Also, if you and your EHR don’t get along well, many physicians can spend unnecessary time after hours to finish charting. If you add meaningful use 1 and 2 documentation requirements, then EHRs can become overwhelming!

There are solutions to most EHR-associated dilemmas. Scribes are a cost-effective alternative to doing your own charts. You can switch to an EHR that is more user friendly, and make the time to learn how to use it correctly. It is very important to fine tune your templates because by doing so you can speed chart completion. I personally have found that using voice dictation software cuts the time completing my EHR charts nearly in half.

Many physicians don’t adequately document office visits to justify the level of service being billed, and this happens whether you use paper charts or an EHR. When documentation is inadequate, practices risk being subject to paybacks and penalties when audited. It is well worth your time to take a coding course so you always document your level of service correctly. Many such courses are available online (see http://emuniversity.com/). Also, have your coders regularly audit your documentation of the level of service provided and you are likely to avoid needing to pay back funds.