David N. Gans

What Does It Cost Physician Practices to Interact with Health Insurance Plans

Physicians have long expressed dissatisfaction with the time they and their staffs spend interacting with health plans. However, little information exists about the extent of these interactions. We conducted a national survey on this subject of physicians and practice administrators. Physicians reported spending three hours weekly interacting with plans; nursing and clerical staff spent much larger amounts of time. When time is converted to dollars, we estimate that the national time cost to practices of interactions with plans is at least

US Physician Practices Spend More Than

23 billion to

15.4 Billion Annually To Report Quality Measures

31 billion each year.

US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers

Each year US physician practices in four common specialties spend, on average, 785 hours per physician and more than

The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality reporting system.

15.4 billion dealing with the reporting of quality measures. While much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report.

Medical Groups’ Adoption Of Electronic Health Records And Information Systems

Physician practices, especially the small practices with just one or two physicians that are common in the United States, incur substantial costs in time and labor interacting with multiple insurance plans about claims, coverage, and billing for patient care and prescription drugs. We surveyed physicians and administrators in the province of Ontario, Canada, about time spent interacting with payers and compared the results with a national companion survey in the United States. We estimated physician practices in Ontario spent

A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign

22,205 per physician per year interacting with Canadas single-payer agency--just 27 percent of the

Medical Groups' Adoption Of Electronic Health Records And Information Systems Practices are encountering greater-than-expected barriers to adopting an EHR system, but the adoption rate continues to rise.

82,975 per physician per year spent in the United States. US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans--nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately

Preparing Your Practice for the Adoption and Implementation of Electronic Health Records

27.6 billion per year. The results support the opinion shared by many US health care leaders interviewed for this study that interactions between physician practices and health plans could be performed much more efficiently.

INCREMENTAL COST ESTIMATES FOR THE PATIENT-CENTERED MEDICAL HOME

Background: Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators. Purpose: To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States. Methodology: We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues. Findings: Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators’ recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare’s PQRS reports impeded use of the data by administrators to support quality management. Discussion: Group practice administrators are playing a prominent role in activities related to the quality of patient care—they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results. Practice Implications: More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if supported by more useful forms of quality reporting.