Peering into the black box: Billing and insurance activities in a medical group

Health Affairs

Volumn 28, Issue 4, 2009, Pages

  Sakowski, Julie Ann ^a,b   Kahn, James G ^b   Kronick, Richard G ^c   Newman, Jeffrey M ^b   Luft, Harold S ^b,d  

^a Sutter Institute for Research and Education   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

^d PALO ALTO MEDICAL FOUNDATION RESEARCH INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE COST; HEALTH INSURANCE; HEALTH SURVEY; HOSPITAL BILLING; HOSPITAL PERSONNEL; MEDICAL INFORMATION; PHYSICIAN;

GROUP PRACTICE; HEALTH PERSONNEL; INSURANCE CLAIM REPORTING; INSURANCE, HEALTH; INTERVIEWS AS TOPIC; PRACTICE MANAGEMENT; TASK PERFORMANCE AND ANALYSIS; UNITED STATES;

EID: 67651230237     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.4.w544     Document Type: Article

References (18)

1. K.E. Thorpe, "Inside the Black Box of Administrative Costs," Health Affairs 11, no. 2 (1992): 41-55.
2. S. Woolhandler, T. Campbell, and D. Himmelstein, "Costs of Health Care Administration in the United States and Canada," New England Journal of Medicine 349, no. 8 (2003): 768-775.
3. J.G. Kahn et al., "The Cost of Health Insurance Administration in California: Estimates for Insurers, Physicians, and Hospitals," Health Affairs 24, no. 6 (2005): 1629-1639.
4. H. J. Aaron, "The Cost of Health Care Administration in the United States and Canada - Questionable Answers to a Questionable Question," New England Journal of Medicine 349, no. 8 (2003): 801-803.
5. L. Casalino et al., "What Does It Cost Physician Practices to Interact with Health Insurance Plans?" Health Affairs 28, no. 4 (2009): w533-w543 (published online 14 May 2009; 10.1377/hlthaff.28.4.w533).
6. This includes responses from twenty physician and fourteen nonphysician clinicians.
7. See J.S. Armstrong, Principles of Forecasting: A Handbook for Researchers and Practitioners, 1st ed. (New York: Springer, 2001), 222.
8. Bureau of Labor Statistics, "San Francisco-Oakland-San Jose, CA: National Compensation Survey, March 2006," Bulletin no. 3135-33, 2007, http://www.bls.gov/ncs/ocs/sp/ncbl0871.pdf (accessed 1 May 2009);
9. and BLS, National Compensation Survey: Occupational Wages in the Pacific Census Division, June 2006, September 2007, http://www.bls.gov/ncs/ ocs/sp/ncbl0960.pdf (accessed 1 May 2009).
10. Medical Group Management Association, Cost Survey: 2006 Report Based on 2005 Data (Englewood, Colo.: MGMA, 2006).
11. Ibid.
12. Truncating the outliers resulted in a 14 percent decrease in mean values. Without adjusting the survey results for these outliers, we estimated that physicians spend forty minutes per day on clarifying claim information, formulary issues, obtaining authorizations, and providing second opinions. Eliminating rather than truncating outliers resulted in an estimated thirty minutes per day spent on these activities. Without adjusting the survey results for outliers, we estimated that clinic-based nurses, medical assistants, and other nonclinicians spend forty-five minutes per day on clarifying claim information, formulary issues, and obtaining authorizations and second opinions. Eliminating outliers from the sample reduces this estimate to thirty-three minutes per day.
13. Includes allocated overhead.
14. Kahn et al., "The Cost of Health Insurance Administration in California."
15. A. Gottschalk and S.A. Flocke, "Time Spent in Face-to-Face Patient Care and Work Outside the Examination Room," Annals of Family Medicine 3, no. 6 (2005): 488-493.
16. C. Pope, "The Cost of Administrative Complexity: Administrative Intricacies Add No Value to Health Care - but the Costs Keep Stacking Up," MGMA Connex 4, no. 10 (2004): 36-41.
17. D.K. Remler, B.M. Gray, and J.P. Newhouse, "Does Managed Care Mean More Hassle for Physicians?" Inquiry 37, no. 3 (2000): 304-316;
18. and Casalino et al., "What Does It Cost Physician Practices?" both report that physicians spend three hours per week on insurance-related matters.