Table 2.
Factors Associated with Physician Productivity (wRVUs/hour) in Generalized Estimating Equation Models
| IRR (95% CI) | p-value | |
|---|---|---|
| Characteristics | ||
| Physician gender: Women (men as reference) | 0.92 (0.79–1.08) | 0.31 |
| Physician age (25–44 as reference) | ||
| 45–54 | 1.01 (0.94–1.09) | 0.73 |
| 55–64 | 1.07 (0.97–1.17) | 0.16 |
| 65 + | 1.06 (0.96–1.17) | 0.26 |
| Practice characteristics | ||
| Panel count | 1.00 (1.00–1.00) | 0.001 |
| Panel gender ratio, proportion female | 1.12 (0.72–1.72) | 0.62 |
| Panel complexity | 1.03 (0.95–1.10) | 0.52 |
| Minutes per visit | 0.98 (0.97–0.98) | < 0.001 |
| Proportion of available appointments filled | 1.41 (1.22–1.63) | < 0.001 |
|
EHR use metrics All time-based metrics are per completed clinical hour |
||
| Quartiles for EHR work outside of scheduled hours | ||
| 1st (WOW < 3.28 min) | Reference | |
| 2nd (WOW 3.28–6.70 min) | 0.99 (0.96–1.02) | 0.64 |
| 3rd (WOW 6.70–11.41 min) | 1.01 (0.97–1.06) | 0.54 |
| 4th (WOW > 11.41 min) | 1.04 (0.98–1.09) | 0.17 |
| Quartiles for time on documentation | ||
| 1st (note < 8.85 min) | Reference | |
| 2nd (note 8.85–12.51 min) | 0.98 (0.95–1.01) | 0.14 |
| 3rd (note 12.51–16.93 min) | 0.95 (0.92–0.99) | 0.005 |
| 4th (note > 16.93 min) | 0.94 (0.90–0.99) | 0.011 |
| Quartiles for time on inbox | ||
| 1st (IB < 4.71 min) | Reference | |
| 2nd (IB 4.71–6.53 min) | 1.01 (0.97–1.05) | 0.74 |
| 3rd (IB 6.53–8.99 min) | 1.00 (0.96–1.04) | 0.99 |
| 4th (IB > 8.99 min) | 1.02 (0.97–1.08) | 0.34 |
| Quartiles for time on orders | ||
| 1st (orders < 5.74 min) | Reference | |
| 2nd (orders 5.74–7.32 min) | 1.01 (0.97–1.05) | 0.57 |
| 3rd (orders 7.32–9.40 min) | 1.01 (0.98–1.05) | 0.44 |
| 4th (orders > 9.40 min) | 1.02 (0.99–1.06) | 0.19 |
| Quartiles for time on chart review | ||
| 1st (review < 4.96 min) | Reference | |
| 2nd (review 4.96–6.79 min) | 1.01 (0.98–1.03) | 0.46 |
| 3rd (review 6.79–9.62 min) | 1.03 (1.00–1.07) | 0.05 |
| 4th (review > 9.62 min) | 1.03 (0.98–1.07) | 0.24 |
| Proportion of orders with team contribution | 1.41 (1.26–1.58) | < 0.001 |
| Proportion of note characters typed or dictated by MD | 0.53 (0.37–0.77) | 0.001 |
|
Proportion of note characters contributed by MD vs other team member |
1.03 (0.98–1.10) | 0.17 |
| Temporal trends | ||
| COVID wave (Feb. 2020 and before as reference) | ||
| March–June 2020 | 0.87 (0.83–0.91) | < 0.001 |
| July–Oct. 2020 | 1.01 (0.99–1.04) | 0.21 |
| Nov. 2020–March 2021 | 1.11 (1.08–1.14) | < 0.001 |
| April–June 2021 | 1.07 (1.04–1.11) | < 0.001 |
| E/M code change (before Jan 2021 as reference) | 1.04 (1.01–1.07) | 0.02 |
Abbreviations: CI confidence interval, COVID, coronavirus disease of 2019, EHR electronic health record, E/M evaluation and management, IRR incidence rate ratio, wRVU work relative value unit, WOW work outside of scheduled hours, IB inbox