David Sakamoto1. 1. John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA. dts@hawaii.edu
Abstract
BACKGROUND: The American health care system contains a layer of administrative controls that has become increasingly burdensome to medical practices in terms of uncompensated physician and staff time and practice costs. A primary care physician in solo practice spends between 4 and 10 hours a week directly interacting with health insurance companies and his or her staff will spend an additional 60 hours a week. This reduces patient-care availability, net practice income and physician job satisfaction. METHODS: A literature review was conducted to determine possible solutions to administrative burdens physicians face in Hawai'i. A total of 51 articles were found matching search criteria with five being reports from major organizations. RESULTS: Twenty-seven articles were found that related to administrative simplification. The "administrative complexity" problem has been defined and its financial impact quantified. Promising solutions have been developed and proposed by private not-for-profit organizations and by the government, both state and federal. DISCUSSION: A successful administrative simplification plan would: (1) Provide rapid access to insurance information; (2) Allow medical practices to readily track specific claims; (3) Streamline the preauthorization process through the use of decision-support tools at the practice level and by directing interactions through real-time network connections between insurers and provider electronic health records, thus minimizing phone time; (4) Adopt the Universal Provider Datasource system for provider credentialing; and (5) Standardize (to the greatest degree possible) provider/insurer contracts. These solutions are outlined in detail.
BACKGROUND: The American health care system contains a layer of administrative controls that has become increasingly burdensome to medical practices in terms of uncompensated physician and staff time and practice costs. A primary care physician in solo practice spends between 4 and 10 hours a week directly interacting with health insurance companies and his or her staff will spend an additional 60 hours a week. This reduces patient-care availability, net practice income and physician job satisfaction. METHODS: A literature review was conducted to determine possible solutions to administrative burdens physicians face in Hawai'i. A total of 51 articles were found matching search criteria with five being reports from major organizations. RESULTS: Twenty-seven articles were found that related to administrative simplification. The "administrative complexity" problem has been defined and its financial impact quantified. Promising solutions have been developed and proposed by private not-for-profit organizations and by the government, both state and federal. DISCUSSION: A successful administrative simplification plan would: (1) Provide rapid access to insurance information; (2) Allow medical practices to readily track specific claims; (3) Streamline the preauthorization process through the use of decision-support tools at the practice level and by directing interactions through real-time network connections between insurers and provider electronic health records, thus minimizing phone time; (4) Adopt the Universal Provider Datasource system for provider credentialing; and (5) Standardize (to the greatest degree possible) provider/insurer contracts. These solutions are outlined in detail.
Authors: Lawrence P Casalino; Sean Nicholson; David N Gans; Terry Hammons; Dante Morra; Theodore Karrison; Wendy Levinson Journal: Health Aff (Millwood) Date: 2009-05-14 Impact factor: 6.301