| |
 |
San Diego Union-Tribune: Bureaucracy won't contain costs
By David Charles
Two new studies document what doctors have known for years: the bureaucratic red tape involved with health plan pre-approvals and denials of care are dramatically inflating the costs of health care. Not only that, but they are robbing physicians of time that could otherwise be spent providing care to patients.
As the Congress and the Obama Administration debate health care reform, these new studies serve as a cautionary tale against plans that contain costs by creating more bureaucracy.
The new research finds that our nation spends $31 billion a year on the bureaucratic costs that result when physicians and patients are made to jump through hoops in order to gain access to tests, medications and care. Not one nickel of that $31 billion goes toward diagnosing an illness, curing a disease or easing a patient's pain. Most of the money is wasted forcing doctors and their staff to fill out mountains of paperwork and place countless calls to insurance companies begging that their patients have access to the proper care — sometimes causing serious delays.
Both studies were funded by independent foundations and published in the journal Health Affairs. One is a national study of physician practices authored by Lawrence M. Casalino, a physician, and his colleagues at Weil Cornell Medical College. The other is a study of a large group medical practice in California conducted by Julie Sakowski of the Sutter Health Institute for Research and Education.
According to the national study, physicians on average spend three hours a week on insurance issues. In my experience, these issues tend to involve dealing with the frustrating pre-approval process, which seems intended to deny or delay access to care.
This bureaucratic runaround is most damaging to small primary care practices, but the trend is the same for specialists and larger primary care groups. In all practices the most time was wasted settling issues concerning drug formularies. This is certainly true in my practice. “Red tape” issues like this rob patients of time with their doctor and waste valuable health care resources.
The national survey tells us that each year primary care practices spend an average of $64,859 worth of physician time addressing insurance requirements. The average number goes up to $78,913 for specialists. This is certainly confirmed in the California study, which made a detailed analysis of a large multi-specialty medical group. In order to handle billing and insurance related functions the practice had to hire two full-time administrative employees for every three full-time physicians. And physicians themselves spent an average of 35 minutes a day on administrative tasks. Bottom line: for each of the physicians in the group, the practice was paying $85,276 in billing and insurance costs.
Patients, of course, are the ones paying the highest price when administrative red tape costs them not just money and time, but peace of mind as well. When a health plan refuses to cover a drug or treatment prescribed by a patient's doctor, a successful appeal can take weeks of work by the patient and his or her physician as they are forced to fight for the prescribed care. This can involve paperwork and numerous calls to the insurance carrier. In my experience, the most seriously ill patients often don't have the stamina to do battle with a large insurance company.
The findings of these two studies lead to an obvious conclusion. When considering how to rein in costs and pay for health care reform, Congress should look for ways to limit the number of bureaucratic hurdles that insurance plans often force patients and their physicians to clear.
Charles, a physician, is associate professor of neurology at Vanderbilt University and chairman of the Alliance for Patient Access.
READ THE ORIGINAL ARTICLE
# # #
All News Items
August 26, 2010 - The Lund Report: The Best Care Possible: You're Worth It
June 14, 2010 - American Medical News: 10 things health insurers must do to regain trust; The AMA, with endorsement from 68 state and medical specialty societies, outlines steps health plans must take to be credible in the eyes of physicians and patients.
February 27, 2010 - Providence Journal: The creepy third person in doctor’s exam room
November 28, 2009 - Newport News Daily Press: MDs under attack
November 04, 2009 - The Hill: A code of conduct for health insurers
October 27, 2009 - WCBU-FM 89.9 (Peoria, Ill.) radio news
October 26, 2009 - WEEK (NBC - Peoria, Ill.): Developing a doctor-patient relationship
October 12, 2009 - Las Vegas Business Press: Here's a prescription: A health insurers code of ethics
September 09, 2009 - Maryland State Medical Society Resolution 14-09
August 29, 2009 - The Island Packet: AMA code puts doctors, patients in charge of care
August 28, 2009 - Baltimore Times: Group calls on health insurers
August 27, 2009 - Baltimore Times: Nursing Maryland back to health
August 20, 2009 - Lincoln Journal-Star: Pharmacists forced to serve insurers rather than patients
August 19, 2009 - WSTM-NBC3: Prescription medication battle heats up in Central New York
August 17, 2009 - New York State Senator Jeffrey D. Klein blog: For Health or Profit? Klein Unveils Sickly Scorecard of Major HMOs
August 17, 2009 - New York Daily News: Prescription Prescription drug coverage marred by bureaucracy, survey says
August 13, 2009 - Leading African American Groups Call On Health Insurers to Dismiss Restrictive Practices
August 13, 2009 - San Diego Union-Tribune: Bureaucracy won't contain costs
August 01, 2009 - Huntington, W.V. Herald-Dispatch: Insurers put stress on the physician-patient relationship
July 21, 2009 - Chicago Tribune: They authorized back surgery but denied his $148,000 claim
July 17, 2009 - American Osteopathic Association calls for Development of Code of Conduct
July 12, 2009 - Houston Chronicle: Another kind of remedy for the sick; Code of conduct would protect patients
July 07, 2009 - Washington Post: Health Reform: Who Holds the Reins on Care?
July 06, 2009 - NATIONAL HEALTH INSURER CODE OF CONDUCT HITS 1000 SIGNATURES OF SUPPORT
June 30, 2009 - Atlanta Journal-Constitution: Code of conduct needed for health insurers, too
June 24, 2009 - Penn. Pharmacists Association: “A Patient Walks Up to the Counter …”
June 24, 2009 - Pittsburgh Post-Gazette: Broken bonds; The physician-patient relationship is being destroyed by the cost-driven decisions of health insurers
June 09, 2009 - Bellingham (Wash.) Herald: Time for a health insurance code of conduct
June 08, 2009 - Mississippi Business Journal: Transparency is the best medicine; Health Insurer Code of Conduct may improve the quality of care
June 03, 2009 - Frederick (Md.) News Post Op-Ed: Pharmacists pawns in health care's game of chess
June 01, 2009 - KUSI-TV interview with Dr. Jack Schim
May 25, 2009 - San Francisco Chronicle: Doctor pushes back against insurer scrutiny
May 08, 2009 - Fox News Health Blog: Bad Medicine: Is Your Insurance Company Hazardous to Your Health?
April 27, 2009 - Petition for Health Insurer Code of Conduct Garners Widespread National Support
April 20, 2009 - On-line petition launched in support of a national health insurer code of conduct
April 13, 2009 - Petition launched in support of a national health insurer code of conduct
April 09, 2009 - Westchester (N.Y.) Herald letters: Access to Quality Healthcare
April 01, 2009 - Los Angeles Society of Allergy, Asthma & Clinical Immunology Applauds the AMA for Developing Health Insurer Code of Conduct
March 24, 2009 - Arizona Republic: Patient care, not financial gain, must take priority
March 22, 2009 - Rochester (N.Y.) Democrat and Chronicle: Health insurers should agree to a code of conduct
March 20, 2009 - Buffalo News: Code of conduct would protect patients from insurers
March 10, 2009 - AfPA Launches Petition in Support of a National Health Insurer Code of Conduct
March 09, 2009 - Texas Medical Society: Health Insurance Code of Conduct Act of 2009; The Time Has Come
March 09, 2009 - American Medical News: MSSNY president: Insurer settlements highlight need for code of conduct
February 01, 2009 - Colorado Medicine: Health Insurer Code of Conduct?
January 24, 2009 - Fresno Bee: Doctors push code of conduct for insurers
December 10, 2008 - Lupus Agencies of New York State Applaud AMA's Resolution to Develop a "Code of Conduct" for Health Insurers
December 09, 2008 - New York State Rheumatology Society Position Paper: AMA Resolution 823
November 20, 2008 - National Minority Quality Forum Applauds AMA's Health Insurer Code of Conduct
November 14, 2008 - Alliance for Patient Access Applauds AMA's Health Insurer Code of Conduct
November 13, 2008 - Alliance for Better Medicine Calls on California Health Insurers to Adopt a "Code of Conduct"
November 13, 2008 - Los Angeles County Medical Association Reinforces AMA's Call for a Health Insurer Code of Conduct
|
|
This website is a project of the Alliance for Patient Access.
 |
|
|
|
