Physicians spend three hours per week—or 43 minutes on average per workday—interacting with health insurance plans about authorization, formulary, claims/billing, credentialing, contracting, and quality data, according to a new study in Health Affairs. That averages out to a cost of about $68,000 per physician per year, the study found.
Physicians spend three hours per week–43 minutes on average per workday–haggling over claims, credentialing, authorizations, formularies, and other issues with health insurance plans, according to a study released today in Health Affairs.
"These data are yet another indicator of the dire need to streamline healthcare administration for physician practices," says William F. Jessee, MD, president and CEO of Medical Group Management Association, which sponsored the study.
The study found that primary care physicians spend more time dealing with health plans than specialists. Nursing staff spend nearly four hours per physician per day interacting with plans; and clerical staff average 7.2 hours per day. Solo practitioners and their staffs spend up to 50% more time interacting with health plans than physicians in larger practices. Non-physicians' staff time did not vary significantly by specialty.
Douglas Henley, MD, executive vice president and CEO of the American Academy of Family Physicians, says he's not surprised that primary care physicians and their staff spend the most time haggling with insurers. "It's because of the diversity of their practices compared with subspecialty colleagues," Henley says. "It's a huge burden for the whole system but particularly for primary care."
Henley says some physician interactions with insurers save money elsewhere in the system with issues like pre-certification, "but a large chunk of those dollars are for an unnecessary administrative burden that could clearly be streamlined."
Most primary care physicians contract with several health insurance companies, Henley says, and each company may offer five or six different coverage plans. "What is the copay? What is the deductable? How much of that has been paid? What drugs are or aren't on their formulary? What are the levels or different tiers of the formulary? It's all different," Henley says."We are talking about standardizing health information technology, and we ought to be able to standardize this type of administrative complexity and get beyond it."
Robert Zirkelbach, spokesman for America's Health Insurance Plans, says he can't dispute cost claims in the MGMA study "until I see what they calculated or how." However, he says, AHIP is sympathetic to providers' concerns about the complicated, time-consuming, and expensive administrative processes that he says also waste money and time for health plans.
"This is not by any means a one-sided issue," Zirkelbach says. "Everybody agrees that we have to do more in the areas of health information technology to improve efficiencies and make the system work better for everyone involved."
In response to this issue, MGMA wants a three-step reform plan that Jessee says could save about $40 billion annually.
The MGMA recommendations include:
Promulgation of a national health plan identifier regulation by HHS, which would simplify and improve healthcare transaction routing and save an estimated $8.8 billion annually
Promulgation of national electronic claim attachment regulation, which would eliminate lost paper claims, accelerate the adjudication process, and eliminate the costs associated with filing and mailing paper documents, saving $9.4 billion annually
Standardize machine-readable patient ID cards, which would reduce claims errors and administrative costs, and eliminate many costs associated with paper records for a savings of $22.2 billion annually
The study classified interactions with health plans as authorization, formulary, claims/billing, credentialing, contracting, and quality data. Of those interactions, practices spend the most time dealing with formularies: physicians spend 1.3 hours per week and nursing staff spend 3.6 hours per physician per week. Primary care physicians spend the most time--1.7 hours weekly--on formulary issues. Physicians and their staffs spend the least amount of time on submitting or reviewing quality data.
Henley says the problem could get worse if Medicare adopts reforms that will install the same administrative requirements as the private plans, such as for pre-certification. "If they subdivide that in certain way, that could create an additional and unnecessary administrative burden," he says.
Zirckelbach says the health insurance industry is pushing for standardization and uniformity in information exchange and administrative procedures to "help physicians to interact with all of the health plans they contract with. This is an area that we have prioritized," he says.
The survey includes responses from 1,310 primary care physicians, 580 specialists, and administrators from 629 group practices. The study does not distinguish between the interactive time spent with public and private health plans.
It's the fear of any hospital administrator. The emergency room is backed up again because blood tests aren't being run quickly in the lab, creating a bottleneck throughout the system. Or, patients can't be diagnosed also because there's no radiology tech to operate the CT.
That's a realistic future scenario in California and many other states now realizing that their so-called "invisible workforce" of allied health professionals, such as nurses, clinical lab scientists, respiratory therapists, and pharmacists, are closing in on retirement. And there are far fewer younger workers on their way in to replace them.
"The age of our allied health professionals is higher, but we're not educating enough people to take their place when they move on," says George Proctos, vice president of human resources for Healdsburg District Hospital, a 43-bed critical access facility north of Santa Rosa.
Add to the problem the increasing demand for such skills from biotech and academic settings, especially as the patient population ages and demand for personalized medicine increases.
"Allied health" is a broad category of health worker, but most dire shortages are seen for nurses, clinical lab scientists, medical lab technicians, imaging technologists for MRI, mammography, ultrasound and nuclear medicine, respiratory and physical therapist, pharmacists, and pharm techs, says Cathy Martin, director of the California Hospital Association's workforce project.
That's why the CHA held a day-long workshop this week for colleges looking for solutions. They want to increase their medically-trained students as well as more faculty to keep the pipeline open. And one way to do that is to encourage hospitals, labs, workforce training programs, and labor unions to work together to get more young and diverse students into these fields, Martin says.
Arrangements may be worked out to allow more students on-site, hands-on training in clinical settings, or find ways to allow some workers with a few required skills to take additional courses and be recertified without starting the educational process anew.
Pay scales are also an issue, with some required workers starting at just slightly above the minimum wage in rural communities as opposed to much higher salaries in urban areas.
The U.S. Bureau of Labor Statistics reports 69,000 more clinical lab scientist and 68,000 more medical lab technicians will be needed by 2012. But education programs currently in existence produce only 4,500 graduates annually, resulting in a 9,200 annual shortfall nationally.
According to one study by the Heath Workforce Solutions project, 60% of the health occupations in California are in allied health and are experiencing shortages now. In just five years, another 206,000 additional health professionals will be needed throughout the state.
Even now, those signs of shortage are starting to appear, says John Bibby, human resources official for two Catholic Healthcare West Hospitals in Ventura County, who now relies on sharing some technicians with other hospitals, or using registries to fill some nursing and other allied professional positions, which is more expensive.
He'd much rather hire his own to ensure security and dependability for St. John's Regional Medical Center and St. John's Pleasant Valley Hospital.
"A few years from now, our clinical lab scientists will be moving on, and we'll have a gap unless we resolve this problem," he says. "If we don't have the proper people to run these patients through our emergency departments, it will mean more delays in patient care."
Bibby says it hasn't gotten to the point where he's desperate. But a few years ago, he wouldn't look at a professional without some experience. "Today, we'd hire a student coming out of college with a certificate or degree where that wouldn't be my first choice before."
Martin says that regional solutions are the key. One good thing is that funds from the American Recovery and Investment Act allows Workforce Investment Boards (regional agencies that give federal, state, and local funding) to allocate money to community college districts needing to increase their reach, where they couldn't before, Martin says. "That has allowed new partnererships."
The workshop, funded in part by the California Endowment, was held one month after Gov. Arnold Schwarzenegger announced a $32 million, three-year public-private partnership to train lab techs, dental hygienists, and pharmacy techs.
President Barack Obama and Democratic leaders have promised to push a sweeping healthcare overhaul through Congress at top speed. "We've got to get it done this year, both in the House and Senate," Obama said. "We don't have any excuses. House Speaker Nancy Pelosi said that the full House would vote on the proposal before members leave town for their August recess.
Alarmed at Republican attacks on President Obama's healthcare proposals, Senate Democrats met with White House officials to formulate a response. Democrats said they felt an urgent need to devise a message to answer Republicans assertions that Obama's proposals could lead to a Washington takeover of healthcare.
Women were found to be more likely than men to face difficulties getting necessary care because they cannot afford it.
In fact, about half (52%) of working age women, compared with 39% of men, reported a variety of problems, such as not being able to fill prescriptions, visit physicians or specialists, or get medical tests, according to a new study from the Commonwealth Fund.
In the study, "Women at Risk: Why Many Women Are Forgoing Needed Health Care," the researchers found that seven of 10 working age women have no health insurance coverage or inadequate coverage, medical bill or debt problems, or problems getting needed healthcare because of cost.
Overall, many women could find themselves "much sicker and in greater need of healthcare services in the future," the researchers said. “Therefore, health reform policies that would expand access to affordable, high quality coverage are critical—for women and men, and the families they care for," according to the study.
Because women are more likely to use healthcare services than men, they were more likely to be exposed to the fragmentation and weaknesses of the current healthcare delivery system, the researchers said.
Those women who were insured—but had inadequate coverage—appeared to be especially vulnerable: 69% of the underinsured women had problems accessing care because of costs, compared with half (49%) of underinsured men. Women also felt the impact more of high healthcare costs because they had lower average incomes and used the healthcare system more often—therefore facing higher out of pocket health costs than men.
Because of high healthcare costs, women and their families are more likely to be faced with making tough choices between obtaining healthcare and buying everyday necessities or making payments on mortgages or credit card debt.
The researchers say the study understates the current scope of this problem, because it is based on data from the Commonwealth Fund's 2007 Biennial Health Insurance Survey. The current economic climate has led to greater unemployment and greater loss of insurance coverage, they said.
On Nancy-Ann DeParles' houlders rests the Obama administration's top domestic policy goal: to cover millions of uninsured Americans, improve care nationwide and control skyrocketing medical bills that are devouring personal, corporate, and government budgets. When former senator Thomas A. Daschle withdrew from consideration for the post because of tax troubles, White House Chief of Staff Rahm Emanuel persuaded Deparle to leave the lucrative private sector and return to government. Her first gambit in the health battle illustrates the challenges DeParle faces.
Atlanta-based Grady Memorial Hospital plans to close three of its nine neighborhood clinics sparked outrage from some officials and fears from patients that they will lose their healthcare. Grady CEO Michael Young said no patients will lose services, since each of the health clinics will consolidate with other Grady clinics about five miles away. Young added patients will actually receive better services, as the clinics on the chopping block offer limited services.
Minneapolis-based Hennepin County Medical Center announced it will eliminate 75 to 100 jobs by the end of June to save money, its second round of layoffs since January. The hospital will also delay buying a piece of property in downtown for a new outpatient care building. A spokesperson said the hospital has not pinpointed which workers will lose their jobs, or the specific services affected. The hospital will also require administrators, managers, and supervisors to take two days off without pay this year to save money.
Clostridium difficile, commonly known as C difficile or C-diff, is rapidly gaining ground as the second-most destructive source of hospital-acquired infection after methicillin-resistant Staphylococcus aureus. Like MRSA, C-diff is also appearing more frequently in the community in patients with no recent history of hospitalization.
