It's No Wonder Physican Offices Can Be Cranky

There's been quite a bit of talk about the inefficiencies of our existing health care system- here's another example.

We all know the route many of us take as patients- we go to the doctor (sometimes we have our health insurance cards, sometimes we don't). We have no clue what our benefits are. If we don't get fixed immediately (we're impatient) we go somewhere else. For those with chronic conditions, we may have to run from one specialist to another, filling out the same forms, and repeating the process all over again. We don't worry about all of the "administrative details", that's the doctor's office problem. We'll just complain when we don't understand the bill.

[I may be a little critical on the "consumer/patient" here- but, unfortunately, it's reality. It's another part of the system that needs to be addressed- consumer understanding/education]

So, what does all of this cost the doctor's office to wade through the mess and hold our hands to deal with "health insurance"? Not surprisingly, a lot.

The May issue of Health Affairs included an interesting article summarizing a study that tried to answer the question of "what does it cost for physicians to interact with health plans today?" You can take a look at the entire article on our site by clicking here.

The study estimates our current process costs our system between $20-$30 billion dollars per year. Each physician/practice deals with over 10 very different and individual "health care programs" and spends on average 3 weeks per year trying to manage the rules of each program. Clerical staffs average almost 40 hours per week (one full-time person) simply to coordinate billings, authorizations, credentialing, and claims. And RN/MA/LPN resources eat up over 9 hours per week trying to navigate through the multiple arrangements. You can probably multiply these numbers further when you include mental health, chiropractic, physical therapy, and some of the other care providers that weren't included in this study.

That's a lot of money- and it is a confusing and frustrating process for everyone involved.

"Technology" is already entering the picture and starting to automate some of these provider/health plan interactions. That's where a lot of our projected savings are going to come from and its the right direction to go. But, getting the technology in place is going to take time.

By simply looking at the numbers, it would seem to us that moving toward some common definition of benefits, formularies, care management protocols, claims processes, and prices between all of the private payers would have the potential of saving a ton of money and reallocate the time currently being spent on "administration" to "care for the patient".

It's pretty obvious that whatever final reform structure we take- we have got to figure a way to organize the mess of programs that are currently out there. It will be better for the payers, the providers, the consumers, and the health care system as a whole.

And, those that are delivering the care to us are likely to be a lot less cranky.