The new May Health Affairs is out on the web, although the hard copy hasn't yet reached my house. This issue is all about primary care reform -and it looks great. There are articles on the lower costs and higher quality of large multispecialty groups, success of one medical home, the roles of NPs and PAs, and much more. I'm just hopeful to have it in my hands before my next plane ride!
In the meantime, a colleague sent me an article from a year ago this week reviewing the cost of interacting with insurance companies for physician offices. In this survey-based study, Casalino et al showed that physicians in smaller practices spent more time dealing with insurers, and in large practices staff spent more time.
Physicians reported that they spent 43 minutes per day (3 weeks of time per year) spent interacting with health plans- for a potential extrapolated cost of $31 billion. As the authors point out, not all of these minutes were wasted; there are time the health plans added real value. The mean was much higher than the median -- so there were some physicians with very high reported health plan interaction time that pulled up the average.
This is not a time and motion study, and physicians angry at the dysfunctional and fragmented system in which they practice might have been blowing off some steam.
My colleague at Mass General Hospital published a study last month of their experience - creating a hypothetical model eliminating the fragmented multipayer system and assuming that there were a single set of transparent and reasonable rules across all health plans. The results were a bit lower estimate of the total cost of health plan interactions, but a higher number of lost physician hours. One way or another, there is a lot of time and effort spent in shuffling of papers and bytes of data back and forth.
We should limit physician-health plan interactions to those that really increase value, either by lowering total cost (including provider and patient resource costs) or improving quality (such as detecting and remedying 'gaps in care.')