Administrative work is the bane of primary care practice, with 95 percent reporting an increase in paperwork over the last 3 years. There are a variety of policy solutions, ranging from single-payer to eliminating fee-for-service.
I agree with Bob Doherty that incremental improvements will be the most realistic option, rather than a wholesale system change. Increasing the adoption of electronic records may help, depending on the commitment doctors have in embracing the technology. Systems that simply scan in paper charts or dictated notes are not utilizing the full potential of an EMR.
I also like the idea of insurers standardizing their forms, like those involving credentialing or pre-authorization for instance, to a universal format. This however, would be a Herculean task given the number of insurers a typical primary care practice accepts. A single-payer won’t be the answer either, since the de facto single-payer for the elderly, Medicare, by itself generates as much administrative work as any private insurer.
topics: paperwork, administrative
Related posts:
- Reducing the paperwork burden on primary care
- How much time do doctors spend on paperwork?
- Administrative costs and single-payer
- The make-believe savings of single-payer
- Pre-authorizations
- Once you hit Medicare age, good luck finding a primary care doctor
- How to get doctors to embrace health care reform
{ 7 comments }
The only way to significantly reduce paperwork at a primary care practice is to drop third party payers.
The third party payers, especially Medicare, need the hassles of paperwork to keep some brakes on physicians’ tendency to spend their money on physical therapy, home nursing, medications or tests on their covered patients.
The paperwork is not some byproduct of the system, it’s an important means of control in a crazy system where everyone spends other people’s money.
If patients paid cash for routine care, then we’d only need a small amount of paperwork for safe communication of clinical information.
Thanks for this topic, Kevin; it’s the paperwork that sucks the life out of me. The purpose of most of my paperwork is to make money for someone else. My thoughts:
We should be allowed to bill for these sevices. Either bill the patient or the entity that demands the form. To this end it would be helpful if the AAFP, ACP, AMA, etc. collaborated on a joint recommendation, including fees.
Sometimes just ignoring the forms, and making the law firm/pill company/podiatrist/scooter company request a second and third time makes the form go away.
What won’t work is more technology. I remember when CVS wanted my fax number, so as “to reduce phone calls”. Since then, realizing they have easier access to me, they’ve burned out several of my fax machines. Now the same people want me to e-prescribe, so as to “cut down the number of faxes”.
In 25 years in medicine, I have yet met an additional piece of technology in the back office that did not increase work. If computerization was efficient for docs, they would have done so already. They aren’t idiots.
The paperwork problem was created by all the docs over the last 40 years who went with the flow and accepted as a defacto standard expectation that doctor will perform other peoples administrative chores for them without charge.
This generation needs to change that. Collect at the time of service and provide a superbill or standard HCFA 1500 and charge for anything else. The paperwork will dry up and you can concentrate on practicing medicine. I you contract with an insurance company then you have agreed to work for them and have no room to complain about their policies.
To Anon 7:07,
You must practice in Beverly Hills.
In the IT world, we say: Standards are good – that’s why there are so many of them. OTOH, why are organizations like AHIMA, whoever organizes HL7 transaction standards and the like not demanding standard forms for everything? The big black box known as third party payers contains infinite variations (like the number of possible drink combinations at Starbucks), all of which are designed to delay and deny.
Actually I am in one of the poorest states in the Union. I just don’t care to do business with people who think that I am a public utility. There are some in all socioeconomic classes who actually believe in paying for what they get and prefer to not subject themselves to institutional manipulation and control. Even outside Beverly Hills, the wise understand that he who pays the piper calls the tune.
Doctors made the paperwork nightmare for themselves by the way they charge.
The practice of charging way more than market value forces everyone to protect themselves with an “insurance” plan that gets them a fair price–it must be fair or the doc wouldn’t take it. The insistance on FFS rather than time charges like other professionals make it more complicated.
I have major medical even though I could pay cash for a CABG tomorrow. In every other area of life I self-insure where I can. In medical care, I buy insurance not because I need the financial backup–but because I will pay 3-5 times as much for the care if I don’t.
So when I go to a doc, the cost is always (so far) under the high deductible. They charge x, and then BCBS whittles it down by 80%. Lots of paperwork for all concerned.
I have a bill here that I paid yesterday for a full H and P, battery of tests, and EKG: total bill of 600$, final bill after all the paperwork: about 200.
Why not just charge everyone 200–or even 300 in the first place (take the insurance companies cut) and make it all simple? The patient comes out even or ahead if they aren’t pre-paying the insurance company.
But no, you keep your charges capricious and impenetrable, driving your patients into the hands of the insurance companies, and then squeel about it.
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