From a doctor's point of view: making billing better, for better care

James E. Bailey, M.D., M.P.H., is a practicing internal medicine physician, director of the Healthy Memphis Data Center and a professor of medicine at the University of Tennessee Health Science Center.  In this post, he riffs on a topic covered by a recent RWJF-supported study, about how streamlining billing procedures will increase efficiency and help improve the quality and cost of health care.

Between the recession and new health reform law, Americans have been thinking a lot about what health care costs. I’ve heard many stories of patients and their families suffering because of the cost of getting care. I also know many primary care doctors and hospitals that do their best to provide everyone the care they need most are finding it difficult to keep their doors open. Again and again, I’ve seen how the health care people receive is often of poor quality, despite its high, and rising, cost. Sadly, Americans end up getting expensive, sometimes even dangerous procedures they don’t need while their most essential health care needs are overlooked.

The health reform debate tended to focus on big, divisive issues—and rightly so. Real change in our health care system will require hard choices to be made by everyone. But there is another big issue—not quite as divisive but nonetheless worth our attention—which is the system’s misuse of time.  Any physician can speak of large amounts of time—and frustration—spent dealing with administrative issues such as billing. As a doctor, I want most to spend my time with my patients. And so every minute I spend on administrative tasks is one less minute I have for seeing patients. And instead of an efficient system that empowers doctors to best do their work, we’ve created a time hog that dictates the priorities of our practices, inhibiting us from doing what we are called to do as physicians—provide care for those who need it.

This is why reform efforts must address issues like the simplification of billing and paperwork. A new study from RWJF's Changes in Health Care Financing and Organization initiative, “Saving Billion of Dollars—And Physicians’ Time—By Streamlining Billing Practices” suggests that it is possible to streamline the billing process, increase the quality of care and eliminate some unnecessary costs. The study examines the U.S. system of billing third-party payers for health care services, arguing that the system of third-party payment is excessively cumbersome, complicated and costly. We spend about twice as much on the billing bureaucracy in America than in any other country in the world.  While it is unlikely that we will be able to eliminate third-party middlemen from the system any time in the near future, there is much that can be done now.

The study notes that many doctors and clinical staff waste large amounts of time dealing with insurance companies, and they believe that a few changes and innovations to the system, based on their hypothetical modeling, could translate into $7 billion worth of savings annually for physician and clinical services. These practical steps include requiring insurance companies to adopt a single set of payment rules, a single claim form, and standard rules for claim submission. This would reduce bureaucracy, save time and money, and get rid of headaches and frustrations for doctors and patients alike.

This study reminds us as physicians and patients how administrative complexity hinders our health care system. The Patient Protection and Affordable Care Act (PPACA), the new health reform law, addresses some issues around administrative complexity in the health system through directives regarding the electronic exchange of health information. But the new law does little to restrain costs related to unnecessary tests and procedures, needless hospitalizations and billing complexities.
 
We must do more to address the fundamental question of how doctors can complete their work without unnecessary administrative complexity, and it doesn’t have to be rocket science.  The large amounts of time and money lost due to administrative complexities are not morally weighty issues. These are issues of efficiency. We know already that rationing care isn’t the answer to controlling costs; rationing only means that people will struggle even more to get the care they need. Perhaps the best advantage of what the article suggests is its ability to be implemented.

Change is necessary—we’ve known that for a long time in health care. But beyond the necessity of big comprehensive change, real change must occur in real time for real people. That means addressing the issues that can be fixed in a straightforward and easy manner today. That means concentrating on what we are capable of doing now. It’s common sense—and we don’t need a prescription for that.