Peering Into The Black Box: Billing And Insurance Activities In A Medical Group: Standardizing benefit plans and billing procedures might help reduce complexity and billing/insurance costs—but only if applied strictly.

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Abstract

Billing and insurance-related functions have been reported to consume 14 percent of medical group revenue, but little is known about the costs associated with performing specific activities. We conducted semistructured interviews, observed work flows, analyzed department budgets, and surveyed clinicians to evaluate these activities at a large multispecialty medical group. We identified 0.67 nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions per FTE physician. In addition, clinicians spent more than thirty-five minutes per day performing these tasks. The cost to medical groups, including clinicians' time, was at least $85,276 per FTE physician (10 percent of revenue).

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Principles of Forecasting

J. Armstrong (2001)

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Costs of health care administration in the United States and Canada.

Steffie Woolhandler, Terry Campbell, David Himmelstein (2003)

A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs. For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars. In 1999, health administration costs totaled at least 294.3 billion dollars in the United States, or 1,059 dollars per capita, as compared with 307 dollars per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada. Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.) The gap between U.S. and Canadian spending on health care administration has grown to 752 dollars per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system. Copyright 2003 Massachusetts Medical Society

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Time spent in face-to-face patient care and work outside the examination room.

Andrew Gottschalk, Susan Flocke (2015)

Contrary to physicians' concerns that face-to-face patient time is decreasing, data from the National Ambulatory Medical Care Survey (NAMCS) indicate that between 1988 and 1998, durations of primary care outpatient visits have increased. This study documented how physicians spend time during the workday, including time outside the examination room, and compared observed face-to-face patient care time with that reported in NAMCS. Using time-motion study techniques, for each of 11 physicians, 2 patient care days were randomly selected and documented by direct observation. Physician time spent on face-to-face patient care and 54 activities outside the examination room were documented. Data represent 12,180 minutes of work and 611 outpatient visits. The average workday duration was 8.6 hours, and face-to-face patient care accounted for 55% of the day. Work outside the examination room relevant to a patient currently being seen averaged 14% of the day. Work related to a patient not physically present accounted for one fifth (23%) of the workday. The combination of face-to-face time and time spent on visit-specific work outside the examination room assessed by direct observation was significantly less than the 2003 NAMCS estimate of visit duration assessed by physician report (13.3 vs 18.7 minutes, P <.001). Nearly one half of a primary care physician's workday is spent on activities outside the examination room, predominately focused on follow-up and documentation of care for patients not physically present. National estimates of visit duration overestimate the combination of face-to-face time and time spent on visit-specific work outside the examination room by 41%.

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Author and article information

Journal

Title: Health Affairs

Abbreviated Title: Health Affairs

Publisher: Health Affairs (Project Hope)

ISSN (Print): 0278-2715

ISSN (Electronic): 1544-5208

Publication date Created: January 2009

Publication date (Print): January 2009

Volume: 28

Issue: Supplement 1

Pages: w544-w554

Affiliations

[1 ]Julie Sakowski () is a senior health services researcher at the Sutter Institute for Research and Education in San Francisco, California, and an assistant clinical professor, Department of Clinical Pharmacy, at the University of California, San Francisco (UCSF). Jeffrey Newman is director of the Sutter Institute and an adjunct professor in the Institute of Health and Aging, UCSF. James Kahn is a professor of health policy and epidemiology, UCSF. Rick Kronick is a professor in the Department of Family and...

Article

DOI: 10.1377/hlthaff.28.4.w544

PubMed ID: 19443478

SO-VID: 3249dfd1-6c8b-451c-96ca-9de91b8f83a5

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Peering Into The Black Box: Billing And Insurance Activities In A Medical Group : Standardizing benefit plans and billing procedures might help reduce complexity and billing/insurance costs—but only if applied strictly.

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International Journal of Applied Technology in Medical Sciences

Most cited references 7

Principles of Forecasting

Costs of health care administration in the United States and Canada.

Time spent in face-to-face patient care and work outside the examination room.

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Journal

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Cited by 16

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