Picture of Anthony M DiGiorgio, DO, MHA, FAANS

Anthony M DiGiorgio, DO, MHA, FAANS

Neurosurgery Economics

I had the honor of testifying before the U.S. Senate Budget Committee on May 8, 2024, to address the critical issue of administrative burdens in healthcare. As an assistant professor of neurological surgery at UCSF, I was also privileged to represent the dedicated physicians of San Francisco and Marin County, who tirelessly advocate for better patient care despite the significant challenges we face daily. My co-witnesses were Dr. David Cutler of Harvard University and Mr. Noah Benedict of Rhode Island Primary Care Physicians Corporation.  I hope my testimony did justice to our humble community.

I spoke to the committee about the increasing administrative burdens on clinicians, which detract significantly from patient care and lead to physician burnout. I’ve written extensively on this topic, highlighting how quality metrics and electronic health records burden physicians, and how we can keep a promise to put patients over paperwork.  I was thrilled when I received an email from congress asking if I would share my thoughts.  The staff were all very knowledgeable, personable and, before I knew it, I was on a flight to DC. 

In my testimony, I focused on administrative burdens stemming from federal regulations. This gave me an opportunity to help educate our lawmakers on steps they could take to reduce these burdens. Physicians today are overwhelmed by tasks mandated by federal regulations, particularly from the Centers for Medicare and Medicaid Services (CMS). These regulations consume a substantial portion of our time, leading to stagnant labor productivity growth in healthcare. Meanwhile, the expansion in the healthcare workforce has been predominantly in administrative roles rather than in patient-facing ones.

CMS’s myriad quality metrics, billing regulations and electronic health record (EHR) mandates have exacerbated this issue. These mandates significantly contribute to physician burnout—a critical issue, with nearly two-thirds of doctors reporting burnout symptoms. Medical students fare no better, with many recognizing the burdens that come with clinical practice; that 61% don’t plan on practicing medicine after graduation. 

Quality programs, such as the Merit-Based Incentive Payment System (MIPS), though well-intentioned, have created a complex web of requirements that often hinder rather than help. While any firm in any industry should measure quality, the top down, heavy-handed methods employed by CMS have had disastrous consequences.  Many metrics, such as the Hospital Readmission Reduction Program, have harmed patients.  These metrics have also driven the increased administrative burdens, tethering physicians to computers and necessitating the hiring of numerous administrative staff to collect and report metrics. 

It’s not just metrics that are tethering physicians to computers.  Despite their potential benefits, EHR systems worsen administrative burdens due to their inefficiencies and the onerous documentation they require.  The “meaningful use” mandates from CMS have resulted in a consolidated EHR market full of cumbersome products.  This has transformed physicians into data and order entry clerks, taking us away from patients.  Numerous studies demonstrate how EHR use has eroded clinical time.  Repealing meaningful use would alleviate many of these burdens. 

To tackle these administrative challenges, we must promote competition in the healthcare market. A system driven by patient choice and provider efficiency can alleviate many of the current burdens. Increasing the penetration of Medicare Advantage and Medicaid Managed Care Organizations can shift CMS from being a plan operator to a plan regulator, focusing on risk adjustment and payment approaches rather than micromanaging care delivery. Additionally, addressing hospital consolidation and fostering competition can lead to more innovative and efficient healthcare solutions.

Speaking on behalf of the physicians in our community was a great honor, as we push for a healthcare system that prioritizes patient care over administrative paperwork. By reducing regulatory burdens and promoting a competitive market, we can enhance the efficiency and quality of care, ultimately benefiting both patients and healthcare providers. It is time to give the market a chance to drive meaningful change in healthcare delivery, allowing frontline physicians to focus on what matters most: providing quality care to patients without the suffocating weight of unnecessary administrative tasks.

In closing, I want to thank the Senate Budget Committee for addressing this vital issue and for giving me the chance to represent the voices of my colleagues in San Francisco and Marin. Together, we can work towards a healthcare system that truly supports its providers and delivers the best possible care to patients.