PLEASE COMPLETE THIS FORM!

I don't think I need to cite a study to prove to any physician that significant physician time is committed to the completion of paperwork. First, there is the medical record: lists for problems and medications, progress note, flow sheets, data base, history and physical form, history and physical update form, procedures, surgical and otherwise, informed consent, sponge counts, operative notes, delivery notes, admission order forms for the acute hospital, nursing home, adult day care, home care, hospice, and various rehab entities, and discharge order forms, to name a few. There are forms for quality improvement, risk management, credentialing, and numerous insurance-related forms related to being a provider. Forms to order labs. Forms to indicate one has seen and acted upon lab and radiologic data. There are newer forms mandated by government entities that require inquiry about risky behaviors, nutrition, and assorted other health risks.

Second, there are payer-initiated authorization forms for services, medical supplies, and durable medical equipment. In like fashion, the managed care industry has contributed a legion of forms documenting the utilization management process.

Third, there are forms related to state or federal reporting requirements. There are numerous conditions that must be reported to the Department of Health Services. Certain types of injuries, or patient-initiated threats of physical violence must be reported to the Department of Justice. Other examples include the reporting conditions likely to impair driving. There are forms to insure that physician report their knowledge of circumstances likely to endanger the safety of children, dependent adults, and the elderly to protective agencies. The National Childhood Vaccine Injury Act of 1986 requires health care providers to report to DHHS using the VAERS form. Some reporting is voluntary, such as reporting of adverse events involving medications, but a form is used for this as well (FDA form 3500). The CMA has helped to develop forms for reporting that simplify the process. Better keep a log of such disclosures, because, with some exception, a patient has the right to receive an accounting of disclosures of protected health information for the six year period prior to the request (new HIPAA requirements).

Finally, there are a plethora of forms that federal, state and county agencies have developed that require physicians to make judgments about a patient's capacity to make decisions about health care, finances, and other matters.

One wonders about the nature of the physician obligation toward all of these forms. Clearly we have a duty where it concerns the direct medical care of the patient. But many of these forms grow outside that duty. In some cases we are compensated. In many cases, there is no compensation. If we choose not to complete the forms, we may fear that patients will not get the care or services they need, or that they may be harmed in some way. If we complete the forms hastily or inaccurately, or if we elect not to complete certain forms, we might do harm to our patients, be accused of fraud, be in violation of contracts we may have signed with health plans or insurers, or face fines or incarceration. A recent article (American Medical News, March 24/31, v. 46 (12), confirms that some physicians are choosing to charge an administrative fee for certain services, and that medical societies and consultants are receiving more phone calls from physicians asking for advice on fee structures.

Important information regarding forms and laws governing forms and reporting may be found in the California Physician's Legal Handbook, a CMA publication. My personal revelation related to the myriad of rules we must adhere to and forms we must complete is as follows:

• Continuing medical education for physicians should include up to date summaries and how-to-do-it-all refreshers, approved by accrediting bodies.
  
  
• Organized medicine should work with the medical board, state, and federal agencies (including HIPAA experts) to standardize the forms and reporting requirements. Medical Societies should examine their role in helping their members with the dilemma posed above, in terms of simpler methods to comply, or when it is OK to charge for the time spent.
  
  
• Medical schools should cover this information through all four years of medical school, to begin to prepare physicians for the deluge.

Many feel that the HIPAA requirement will actually simplify many of the forms we must currently complete -that is encouraging. Physicians currently discouraged by the mountain of paper and complicated compliance requirements they face in modern practice need a break here. There is no getting around some of these requirements but there has got to be a simpler way.