Plan Interactions Cost Doctors 

U.S. physicians, their employees, and their lawyers and accountants may spend an average of about $68,000 in time per physician per year on interacting with health plans.

Researchers have published that estimate in an article in the Web edition of Health Affairs, a health finance journal.

The researchers based their figures on a survey of about 900 physicians and medical group administrators in ordinary solo and group practices. The researchers excluded physicians employed by academic medical centers or health maintenance organizations and some other physicians with unusual practices, such as practices with an unusually large percentage of self-pay patients.

The physicians who participated in the survey reported spending an average of 3 weeks per year interacting with plans. Nurses working with the physicians are spending about 23 weeks per year talking to plans, and clerical staffers spend about 44 weeks per year on plan communications, the researchers estimate.

The $31 billion spent on health plan interactions accounts for about 6.9% of U.S. expenditures on physicians and clinical services, the researchers report.

The researchers note that the time spent on health plan interactions may not necessarily be wasted time. Some of the health plan interactions may produce benefits, by, for example, reducing health care costs or increasing the quality of care, the researchers write.

But researchers should be looking for ways that health plans can make physician practice interactions more efficient, the researchers write.

• • 7/3/2009 4:29:06 AM
  • Robert Baitinger - Insurance Specialist
  • Reasons why "Plan Interactions cost Drs"
  • Put SIMPLY.. It is because ALL medical groups, physicians, and related -- charge TOO MUCH to be begin with. Example, he group I go to charge $158 PLUS for a 20 min visit. Then add SKY HIGH lab fees - which the group controls - they are thiefs! I tell them that to their faces. They should be strung up to dry!! They shrug !!
• • 7/4/2009 12:52:20 PM
  • RDefazio
  • Health care plan interaction costs
  • These costs are unavoidable as long as health care plans insist on having different methods of submitting claim information and as long as they elect not to receive communications from physician offices through a central source. The multiplicity of methods of contact force every interaction with each health care insurer to be "rediscovered" every time a problem arises. While the health provision network of this country has recently found religion in the form of electronic health records (analogies to which Sears and Walmart discovered decades ago), the insurance end of the biz needs to "discover" a uniform method of handling claims and disputes so that it can become a fixed target for the relatively small multiplicity of office practice software companies to hit. Going to a claim clearing house, federal or private, as an "option" for claiming compensation should not be an option. Claim processing should be centralized. The bottom line is that insurers and physicians and attorneys pointing their fingers at each other is tantamount to the kettle calling the pot black. For the longest time none of these camps have been willing to settle on standards that drive industry efficiency. It has taken the not-so-veiled threats of a presidency to makes them start behaving like something other than unruly brats. What I can say is that if real cooperation doesn't materialize very quickly, what will lie in wait for the recalcitrant will be measures similar to that of limiting the compensation of CEOs. Attorneys could face tort reform that turns off the income spigot. Physicians could confront limitations. Insurance companies could be faced with federal coercion that requires them to adopt standards to which they must forcibly adjust their own systems. And patients will likely have to take far more control of their own well being. In order to break the wasteful cycle of allowing oneself to become ill through neglect and bad choices, seeing a doctor whose efforts are delivered with less than stellar diligence and follow through, becoming more ill, and then seeing an attorney to fix one's illness, limitations on the patient's capacity to sue are likely waiting in the wings. Patients must become part of the solution, and that means that they must stop being portrayed as mere hapless victims of an evil medical-insurance industrial complex.
• • 7/6/2009 11:40:58 AM
  • Rusty Perkins
  • Time spent contacting health care plans
  • THat time will grow greatly is national health care is instituted. A large amount of that will be trying to find the right person to speak to and being on hold. This is my experience when dealing with Medicare.

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