LETTER
OBRA Regulations for Nursing Homes—Enhancing Paperwork or Patient Care?
Mark G. Jameson, MD, MPH
1 November 1994 | Volume 121 Issue 9 | Pages 724-725
TO THE EDITOR:
The excellent review by Ouslander and Osterweil [1] and the accompanying editorial by Besdine and colleagues [2] encourage internists to expand their nursing home practice. The OBRA act is specifically revered by the authors as a "gift" to nursing home patients.
As an internist who devotes half of his practice to nursing home patients, I believe OBRA is responsible for physician reticence to practice in nursing homes. To my mind, OBRA stands for "Oppressive Bureaucratic Requirement Act" because it coerces physicians to devote far more time to completing paperwork and attending meetings than to caring for patients. The motto seems to be "paperwork first, patients last." About 75% of my nursing home time is spent on paperwork, all of which is nonreimbursable. I donate considerable time to charitable causes but do not consider Medicare to be a charitable organization. Contrary to the authors' endorsement, OBRA is not a gift to nursing homes from Santa Claus but is instead a gargantuan Grinch.
1. Ouslander JG, Osterweil D. Physician evaluation and management of nursing home residents. Ann Intern Med. 1994; 120:584-92.
2. Besdine RW, Rubenstein LZ, Cassel C. Nursing home residents need physician's services (Editorial). Ann Intern Med. 1994; 120:616-8.
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