Physicians Spend 3 Weeks Per Year Haggling Over Insurance Claims At An Estimated Cost of $58,000 Per Doctor-Time Better Spent Helping Patients
Bennet, with Pueblo Patients, Physicians and Small Business Owners, Discusses Need for Health Care Reform
Pueblo, CO -At Parkview Medical Center in Pueblo today, Michael Bennet, U.S. Senator for Colorado, listened as physicians, nurses, administrators and patients shared their stories of how burdensome insurance company procedures affect patient care and raise health care costs. Bennet also spoke with small business owners who are struggling in the face of double digit health insurance cost increases. The medical administrators and patients discussed the need to shift control from the insurance companies to physicians, nurses and patients.
At the meeting, Bennet said we need health care reform that lowers costs, preserves choice and makes health care more affordable for Coloradans in a fiscally responsible way. Bennet also said health reform needs to ensure that insurance companies can no longer deny patients coverage for pre-existing conditions; drop coverage if they become seriously ill; set caps for when health emergencies occur; and charge patients high costs for medications and doctor's visits.
"By simplifying and streamlining our processes and putting control in the hands of the doctors, nurses and administrators, we can improve patient care and lower costs," Bennet said. "There are common-sense solutions to the bureaucratic mess, and we ought to implement them."
According to the Healthcare Administrative Simplification Coalition, a considerable proportion of the $2.3 trillion expended annually on healthcare in the United States is wasted.
Currently, administrative burdens in the health care system are extremely complex. Physicians are forced to deal daily with private health insurance companies on behalf of their patients. These interactions include obtaining prior authorization before delivering treatment, dealing with drug formularies, submitting claims, submitting quality data, and having physicians credentialed by the insurance companies, among others.
A recent study released by Colorado-based Medical Group Management Association (MGMA), which represents physician group practices across the country, showed that physicians spend over three weeks a year on interactions with insurance companies. The national study estimated that the cost of time spent by physicians in physician group practices is $53,800 per doctor in 2009 dollars and $24.9 billion for office-based physician groups - and this is just for physician practices, not even for physicians or nurses working at hospitals and other facilities.
Meanwhile, the Administrative Simplification White Paper written last year by the American Medical Association states that approximately 25 to 30 percent of the nation's total health care expenditures result from direct transaction costs and downstream inefficiencies associated with the ‘claims management revenue cycle' - the process of creating, submitting and analyzing claims for payment of patient medical bills.
Bennet and the physicians today pointed to several ways that health care reform could simplify the administrative burdens the insurance companies place on health care professionals. These solutions include simplifying claims forms that physicians and nurses fill out, standardizing forms of different insurance companies, and identifying patients in a more streamline manner to insurance companies.
For example, one proposal would enforce the implementation of a National Health Plan Identifier regulation. Different health plans have various codes for all types of procedures and treatments. If a doctor sees ten patients a day, all ten may have different health plans. Because there are no uniform codes, the doctor would then have to ensure that he is correctly billing by the right code for the right plan. Without a standard identification method, providers may have to contact an insurance company directly, treat a patient without knowing if the service will be covered, or wait to treat the patient until they receive approval from the insurance company. Implementation of a National Health Plan Identifier would ensure there is a streamlined, uniform platform for delivering care.
Another proposal would allow physicians and nurses to send claims to insurance companies electronically. Currently, the majority of claims that are submitted to insurance companies must be paper-based. Electronic administrative transactions would allow providers to determine a person's insurance coverage instantly, and would standardize the claim and denial processes.