Description
Describe three to five options that can be considered for addressing the problem by the audience for this policy analysis. Include a description of the positive and negative aspects or pros and cons of each option. Describe the criteria you are using to analyze the pros and cons/positives and negatives for each action. For example, criteria can include cost, feasibility or ease of implementation, legality, fairness, timeliness, or targeted impact on the audience affected by the problem. For your recommendation, you should choose one of the options you described. Describe why this option is preferred over the other options, despite the cons or negative aspects of the policy action. Part 3 will include the following components in a narrative of VIII. Options for Policy Action: 1. 3 to 5 options, 2. Positive and negative aspects or pros and cons of each action. 3. Criteria for analyzing the pros and cons of each action. IX. Recommendation: 1 Description of one of the options for policy action as the recommended action, 2. Description as to why this option is preferred over the other options.
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Cordell King
MPH Capstone Project – Part 1
PUB-690 Public Health Capstone Project
Ormand Clarke
08/30/2023
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Background for the Problem
The problem of less time spent with doctors during appointment visits that typically last
for a standard 15 minutes or less has gained excessive attention over the years. Moreover, the trend
has elicited concerns among healthcare policymakers, professionals, and patients. According to
the American Medical Association (AMA), the standard duration for a doctor’s appointment is 15
minutes, thus established on the premise that it would be enough for medical consultations
(Solomon, 2008). Nevertheless, multiple variables have called for a review of this antique practice.
To begin with, the instances where the doctor’s visit is constrained to 15 minutes imply that the
appointment would address a few issues and thus diminish the in-depth understanding. Therefore,
Mechanic et al. (2001) claim that the time-consuming psychological health determinants would be
unattended within the stipulated duration. The consequences are declined patient satisfaction,
congested emergency service utilization, and noncompliance with diagnosis plans (Geraghty et al.,
2007).
The most significant aspect provided to patients by doctors is time. However, in most cases,
patients feel that they need more time during the doctor’s visits, and doctors normally feel hasty
in their efforts to offer quality care despite being confronted with insurmountable pressure to offer
quality care and engage more patients (Zhu et al., 2010). For this reason, the current standard
duration for visiting physicians for an appointment has been associated with patient dissatisfaction,
low delivery of quality care, and reduced patient outcomes (Geraghty et al., 2007). However,
studies examining the duration of a doctor’s visit have needed clarification on the impact of the
case mix. Furthermore, there is a wide consensus that primary care has declined considerably the
length of patient visits to the doctors for appointments. The case mix of office-based doctor visits
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has become more multifaceted; thus, the average length of the visit may have amplified rather than
declined. For this reason, there is a need for more time for each visit (Zhu et al., 2010).
The most recent study has indicated that 53 percent of healthcare providers experience time
pressure during clinical encounters. For this reason, many providers described exhaustion and fear
of making clinical errors (Mechanic et al., 2001). Moreover, some healthcare providers employ a
free-for-service system that needs to be better developed to deliver comprehensive care. As a
result, some healthcare providers feel like they are on the manufacturing line instead of engaging
in a mission to treat the sick and diagnose chronic illnesses. Mechanic et al. (2001) state that the
standard duration prescribed by AMA needs to be longer as the current one allows patients to
initiate a few topics ask a few questions, and curtly answer the questions. As a result, the doctors
may underestimate the severity of their conditions (Solomon, 2008).
Why the problem has been selected
The selected problem for analysis is an important aspect of delivering quality primary care
due to its impact on patient outcomes. Mechanic et al. (2001) state that insurance providers pay
clinics, hospitals, and doctors enough to justify the limited 15-minute doctor visits. Manganelli
(2016) further states that the conventional 15-minute time frame for doctor-patient interactions has
existed for a long time and is thus critical to evaluate its adequacy in the modern healthcare
landscape. Multiple reasons justify the selection of the problem:
Dynamic healthcare landscape: In recent years, the healthcare landscape has significantly
revolutionized through advances in medical technology, increased chronic illness, and an aging
population. For this reason, there is a need to enjoy the real benefits of allowing enough visit times
for primary care, such as low hospital utilization and emergency care, improved patient
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satisfaction, reduced unnecessary referrals, and few ill-advised diagnostic treatments (Geraghty et
al., 2007).
The complexity of health issues: Multiple health issues have increasingly become
complex, and thus, there is a need for enough time for diagnosis, patient education, and treatment.
Moreover, patients with several chronic conditions typically need long consultations to manage
their health concerns effectively (Mechanic et al., 2001). Delivering efficient care to patients for a
long duration could avoid the changing needs of the patients, thus resulting in better results and
providing access by minimizing the necessity for return visits (Manganelli, 2016).
Effective Patient-Centered Care: The paradigm shift towards patient care focuses on
shared decision-making, addressing patient concerns, and active listening. However, the current
visit restriction interferes with this technique’s implementation. Additionally, Manganelli (2016)
claims that more time improves communication and would result in clinician satisfaction and wellbeing, critical features in handling the current crisis of dilapidating primary care employees.
Minimizing medical errors: Consultations done hastily can result in medical errors,
missed opportunities, and misdiagnosis in preventive care, which immensely causes severe
consequences in patient health.
Issue Importance and why it needs urgent attention
The 15-minute doctor visit is a significant issue and needs immediate attention for multiple
reasons. Firstly, there is a need to extend the consultation duration to facilitate effective patient
outcomes. Therefore, adequate time provides room for a robust assessment, discussion on
diagnosis options, patient awareness education, and thus, more improved and informed health
decisions (Felix, 2014). Secondly, the long doctor visits will ensure efficient care delivery in
facilities. For this reason, doctors can ask more comprehensive questions, consider a wide range
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of options for diagnosis, and evaluate all the treatment alternatives that will enhance healthcare
quality (Manganelli, 2016). Thirdly, the individual patients will feel that their health concerns are
heard, and questions are answered more comprehensively with their healthcare experience. As a
result, there will be high patient retention and compliance with treatment plans. Fourthly, the study
will also examine how longer visits of more than 15 minute offers an opportunity for health
education and preventive patient care. Ultimately, the strategy will reduce the chronic illness
burden and promote healthy lifestyles (Zhu et al., 2010). Finally, despite seeming
counterproductive, longer doctor visits can improve the healthcare system. Moreover,
comprehensive tackling of the initial patient issues can result in efficiency in the system. As a
result, addressing these issues more comprehensively during initial visits would result in low
follow-up appointments and less expensive medical interventions in the long run (Felix, 2014).
Problem Statement
The issue under review is the outdated practice of restricting doctor’s visits to a standard
15-minute duration or less, which no longer takes care of the multifaceted healthcare needs of
modern patients. Moreover, the outdated approach results in patient dissatisfaction, interferes with
the quality of care, and deters communication efficiency between physicians and patients. For this
reason, there is a need for robust changes that will increase the allocated time for doctor-patient
visits. The fundamental problem statement in the study seeks to determine the following issue:
1. Should there be a comprehensive paradigm shift in healthcare to increase the duration of
doctor-patient consultations and address the increased complexities of healthcare for
enhanced patient outcomes, patient satisfaction, and overall healthcare quality?
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MPH Capstone Project – Part 2
PUB-690 Public Health Capstone Project
Policy Analysis
Overview of Current Policy
In 1992, Medicare established a policy stating that a typical doctor’s visit should be
fifteen minutes. Medicare also found the Relative Value Unit (RVU) formula to calculate
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physician fees effectively and enhance consistency. The formula indicated a typical primary care
doctor visit should be 1.3 RVUs or about fifteen minutes (Linzer et al., 2015). Medicare also set
reimbursement rules for the 15-minute doctor visit policy, influencing private insurance
companies to follow it. Consequently, the 15-minute doctor visit policy became the norm. The
policy has raised critical concerns because it significantly affects patient outcomes and exposes
physicians to time pressure. For instance, Freedman et al. (2021) found that large physician
networks misused the 15-minute policy to maximize their profit by attending to more patients. In
this sense, it influences physicians to focus on money rather than patient satisfaction.
Physicians also experience burnout as they strive to attend to as many patients as
possible. Thus, more than fifteen minutes is needed because physicians spend much time on
computers, keeping and analyzing large volumes of electronic health records regarding patients’
conditions. This time pressure exposes patients to medical errors, including misdiagnoses and
unnecessary drug prescriptions. Sufficient evidence shows that the 15-minute time limit
increases the risk of inappropriate prescription and disease management. Linzer et al., 2015
reveal that time pressure resulting from the 15-minute time limit leads to doctors’ burnout,
undermining the quality of care. Physician burnout is a critical risk factor for medical
malpractices, such as hospital-acquired infections, treatment delays, and inadequate follow-up,
which cause communication problems and inadequate patient assessment (Linzer et al., 2015). In
this sense, the 15-minute doctor visit policy exposes patients to health risks.
Many patients complain about the inadequate time doctors spend with them. According
to Freedman et al. (2021), sixty-five percent of patients feel their time with their physicians is
limited. Only eleven percent of patients and fourteen percent of primary care physicians feel they
spend adequate time together (Freedman et al., 2021). Following the increased population of
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patients with chronic conditions, the 15-minute time limit exposes patients and their families to
frustration as physicians rush them through appointments. The time limit makes many patients
and their families feel overwhelmed, overlooked, and unsatisfied with the US healthcare system.
Although healthcare providers make multiple appointments, they do not aim at shorter
visits. Instead, heavy workloads and overlooked schedules lead to a lack of time with patients.
For instance, Freedman et al. (2021) argue that physicians work an average of fifty-one hours
weekly and attend to twenty patients daily – and a quarter of the time is spent on non-clinical
paperwork. A related study by Freedman et al. (2021) documented that providers spent thirtyseven percent of the fifteen-minute time on paperwork, leaving inadequate time to assess their
patients. This data shows that the 15-minute doctor visit time limit does not recognize other tasks
physicians perform when assessing the patient, leading to time pressure and patient satisfaction
issues.
Additionally, the 15-minute doctor visit policy influences policymakers to rethink
physician shortages. The demand for medical services increases rapidly following the increased
patient and aging populations. The policy exacerbates the physician shortage issue since the time
limit influences patients to book additional appointments to revisit physicians. Freedman et al.
(2021) reveal that inadequate physicians in the US lead to longer waiting times for appointments,
increased patient costs, and decreased quality of patient care. Thus, policymakers are seeking
effective ways to maximize the 15-minute limit for doctor visits.
Key Stakeholders
Healthcare providers are critical stakeholders in analyzing the 15-minute doctor visit
policy because they face time pressure and burnout, minimizing productivity. Engaging
healthcare providers in developing the 15-minute doctor visit policy can help increase
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productivity in primary care units. Primary care reflects the first contact for many patients and
informs initial diagnosis and treatment. Understanding how the 15-minute doctor visit policy
affects the primary care providers’ productivity can help address time pressure and burnout
issues. The primary care providers’ productivity comprises the care quality (i.e., the number of
patients and health conditions attended per visit and the care quality) along multiple dimensions
that patients and players may not observe. The 15-minute time limit is a critical factor for the
structure of the primary care providers because it influences the provider-patient relationship,
accuracy, and decision-making (Swanson et al., 2022). Swanson et al. (2022) also found that half
of the physicians’ experience time pressure during appointments, and their work pace is chaotic.
In this sense, healthcare providers are vital stakeholders in analyzing the 15-minute doctor visit
policy because they have critical information regarding the policy’s impact on their job
satisfaction and quality of care.
Patients are also vital stakeholders in analyzing the 15-minute doctor visit policy because
it exposes them to relatively long waiting times and health risks. Since fifteen minutes is
inadequate to assess all health problems for patients with multiple chronic conditions, many
patients make additional appointments, leading to an increased number of individuals who want
to see the doctor. Consequently, patients wait relatively long as healthcare providers attend
multiple appointments. Waiting loses valuable time and discourages patients from adhering to
medical treatment (Linzer et al., 2015). In addition, the 15-minute doctor visit policy exposes
patients to health risks associated with medical errors. The time limit exposes healthcare
providers to malpractices that potentially affect patients’ health. In this sense, patients are vital
stakeholders in analyzing the 15-minute doctor visit policy because they possess vital
information regarding its impact on their health and waiting time.
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Moreover, healthcare policymakers are vital stakeholders in analyzing the 15-minute
doctor visit policy because they shape health-related rules and regulations. While the federal
government funds most of the nation’s health care (Medicare and Medicaid), state governments
regulate much of health. At the local level, healthcare policymakers can influence health by
informing decisions about planning and zoning with communities (Swanson et al., 2022). For
instance, local governments can collect data about the impact of the 15-minute time limit on
patients with chronic conditions to improve the quality of care. In addition, healthcare payers
(i.e., the federal government and insurance firms) are essential stakeholders in maximizing the
policy because they pay for medical services. The federal government is the largest payer and
has a constitutional mandate to promote its citizens’ general welfare (Dieleman et al., 2020).
Therefore, the federal government must examine the impact of the 15-minute policy on health
care cost and quality of care. On the other hand, insurance firms must examine the impact of
policy changes on medical coverage to ensure client satisfaction (Dieleman et al., 2020).
Key Factors/Multidisciplinary Impacts
Epidemiological and medical factors are vital in analyzing the 15-minute doctor visit
policy. Caring for socially underprivileged patients involves unique challenges requiring
additional time and teamwork. Communicating with patients from different cultural, language,
and health literacy backgrounds takes a relatively long time. Socially underprivileged patients
also have worse physical and psychological health, including more visual, cognition, and hearing
impairments that slow communication (Schwarz et al., 2022). Healthcare providers must build
rapport and identify patient needs during the visit. Building rapport across ethnicity, race, and
educational level may be challenging. Identifying patient needs and negotiating the appropriate
treatment option can take longer due to additional symptoms, illnesses, and concerns. In
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addition, patients with relatively low health literacy might need to recognize primary symptoms
on time (Schwarz et al., 2022). Schwarz et al. (2022) also reveal that time pressure can
undermine physician empathy, reducing trust in marginalized patients.
Other epidemiological and medical factors to consider in analyzing the 15-minute doctor
visit policy include information-sharing, examination, and decision-making. Gathering
information regarding the illness in marginalized patients, including psychosocial context and
key symptoms, is more time-consuming due to more complex illness and symptoms than in the
general patient population (Schwarz et al., 2022). Exploring the patients’ perspective is vital for
establishing an effective clinical relationship and understanding patients’ beliefs. However,
exploring patients’ perspectives and building effective clinical relationships across various sociocultural backgrounds is more time-consuming.
Economic factors are also vital in analyzing the 15-minute doctor visit policy.
Marginalized patients face severe health inequalities, leading to poorer health status, increased
exposure to patient safety incidents, and higher premature morbidity (Cheraghi-Sohi et al.,
2022). Following increased healthcare costs and limited membership of marginalized
populations in insurance programs, they may need to meet the cost of the additional doctor visits
resulting from time limitations. In addition, physical examination in marginalized patients can
also take longer because of more significant healthcare burdens and disabilities that inhibit
patient care. For example, uninsured marginalized patients may not meet the cost of extended
preventive care requiring disrobing (e.g., breast, rectal, and pap smear exams).
Ethical and legal factors are also vital in analyzing the 15-minute doctor visit policy. Due
to limited time, healthcare providers may refrain from engaging patients with language
limitations in healthcare. Discussion regarding diagnosis and treatment entails sharing illness-
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related information, promoting behavioral change, and complex decision-making. However,
these tasks may require longer for patients with different health beliefs, languages, trust levels,
and cultures. Participatory decision-making may not address the unique needs of marginalized
patients. While the Equality Act 2020 prohibits discrimination against patients based on
protected characteristics (i.e., gender, age, race, pregnancy, sexual orientation, etc.), the time
limit may influence healthcare providers to discriminate against specific patient populations
(Gonzales & Gavulic, 2020). For example, older patients may need to receive appropriate
examinations due to their complex, multiple conditions within fifteen minutes.
Moreover, political factors are vital in analyzing the 15-minute doctor visit policy.
Medicare adopted the RVU in the early 1990s. In a budget-fair system, introducing new
procedures at significantly high RVU levels has undermined cognitive care, including evaluation
and management services. Following reduced compensation by managed care contracts and
private insurers, providers increased daily amounts to stabilize their incomes. Consequently, use
the fee-for-service (FFS) system to maximize the income from daily visits. The FFS system is
ineffective in delivering comprehensive care because it influences primary care providers to
focus on maximizing profits rather than healing patients and preventing severe illnesses (Linzer
et al., 2015). Hence, policymakers should examine the healthcare providers’ willingness to
maximize the 15-minute time limit because healthcare providers are the only beneficiaries
References
Cheraghi-Sohi, S., Panagioti, M., Daker-White, G., Giles, S., Riste, L., Kirk, S., … & Sanders, C.
(2020). Patient safety in marginalized groups: a narrative scoping review. International
journal for equity in health, 19(1), 1-26.
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Dieleman, J. L., Cao, J., Chapin, A., Chen, C., Li, Z., Liu, A., … & Murray, C. J. (2020). US
health care spending by payer and health condition, 1996-2016. Jama, 323(9), 863-884.
Freedman, S., Golberstein, E., Huang, T. Y., Satin, D. J., & Smith, L. B. (2021). Docs with their
eyes on the clock? The effect of time pressures on primary care productivity. Journal of
Health Economics, p. 77, 102442. https://doi.org/10.1016%2Fj.jhealeco.2021.102442
Gonzales, G., & Gavulic, K. A. (2020). The Equality Act is needed to advance health equity for
lesbian, gay, bisexual, and transgender populations—American Journal of Public Health,
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Linzer, M., Bitton, A., Tu, S. P., Plews-Ogan, M., Horowitz, K. R., Schwartz, M. D., &
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Group*. (2015). The end of the 15–20 minute primary care visit. Journal of General
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Swanson, K. M., Matulis III, J. C., & McCoy, R. G. (2022). Association between primary care
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