There’s probably not a physician reading this right now who isn’t shaking his or her head in agreement. But this is something I feel that the public, and perhaps more importantly, policy makers, don’t fully understand. Administrative burdens contribute to physician burnout and patient dissatisfaction, increase the cost of care and ultimately impact overall health outcomes.
There are many issues that fall into this category, but I wanted to highlight a few in particular:
- Prior authorizations: There are no standard processes and there is a lack of efficient online portals. The desire of insurance companies to contain costs also leads to the rationing of care.
- Provider enrollment duplication: It shouldn’t take more than 45 days for a physician to enroll with a payer, but too often is does.
- Use of appropriate CPT codes: CPT is supposed to exist to standardize documentation and payment. But the use of an improper modifier can reduce reimbursement by 50%.
- Consistent reporting of quality measures: Participating in separate quality programs takes an enormous amount of work for physicians and our staffs. Such measures also often have little to do with “quality.”
- Prompt payment: There are many cases where the insurer takes longer than 30 days to pay a clean claim. This is unacceptable. Insurers are able to go back seven years to recoup payments while physicians only have one year to submit a bill. This occurs more than people think.
- RAC audits: Paying auditors based on the amount they collect creates a conflict of interest.
As physicians, we understand that documenting and reporting on the health of our patients is part of the job. But we spend an overwhelming amount of time in front of a computer and not in front of a patient. In fact, my desk right now is so full of papers that I can’t even see the wood underneath! This isn’t sustainable and shouldn’t be acceptable.
That’s why the KMA is working to alleviate some of these administrative burdens. We are currently developing a long-term plan to identify and tackle the issues that are ultimately impeding the delivery of quality care across the Commonwealth. Be on the lookout for more details on this initiative in the coming months.
I hope each of you has a Happy Thanksgiving. I know I’m thankful to be a part of a community of organized medicine that is working to make the state a friendlier place for physicians.