A registered nurse who runs a patient advocacy firm in Chicago says one great way to improve U.S. health care quality would be to take an ax in Medicare and Medicaid paperwork requirements.

Teri Dreher, president of North Shore Patient Advocates, said well-intended efforts to increase the quality of health care and promote efficiency have backfired.

Teri Dreher

Her firm charges an hourly fee to help clients with issues related to care planning, care management, care coordination and insurance billing disputes.

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She said that she and her firm’s other advocates see plenty of low-quality and inefficient care, and that administrative overload seems to be a major cause of quality and efficiency problems.

“If I had a magic wand, I’d make the documentation requirements more efficient,” Dreher said. 

Doctors and nurses are spending so much time feeding data into patient record systems that they barely have time to see the patients, or to try to use the information in the systems to improve patient care, Dreher said.

In the home health services field, for example, the nurses overseeing the care typically spend about 10 percent of their time on patient care, and about 90 percent on recordkeeping and billing, Dreher said.

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Moreover, given how much pressure everyone is under to make the statistics look good, there’s no guarantee that the statistics have much to do with reality, Dreher said.

Drafters of the Patient Protection and Affordable Care Act (PPACA) encouraged Medicare to help primary care doctors set up “patient-centered medical homes.” The medical homes are supposed to provide some of the same kinds of care planning and care coordination services that Dreher’s firm provides.

“I just think it’s not true,” Dreher said.

Dreher’s firm charges a typical client more than $200 per hour. She said an advocate at the firm can help only about four active clients at a time. She laughed at the idea that many primary care doctors can replicate what she does in their offices.

To the extent doctors and nurses do try to get involved with care coordination and the related documentation processes, “it takes them away from the patients’ bedside,” Dreher said. “You don’t get safer care. It’s supposed to lead to better patient care. In reality, it doesn’t.”

Insurers have also set up care coordination programs. Many are telephone-based or Web-based. Those programs may have a place, but they are no substitute for having a coordinator in the field who can see the patient and see the patient’s home, Dreher said.

 

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