US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers (original) (raw)
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What Does It Cost Physician Practices To Interact With Health Insurance Plans?
Health Affairs, 2009
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 23billionto23 billion to 23billionto31 billion each year. [Health Affairs 28, no. 4 (2009): w533-w543
A National Survey of the Arrangements Managed-Care Plans Make with Physicians
New England Journal of Medicine, 1995
Background. Despite the growth of managed care in the United States, there is little information about the arrangements managed-care plans make with physicians. Methods. In 1994 we surveyed by telephone 138 managed-care plans that were selected from 20 metropolitan areas nationwide. Of the 108 plans that responded, 29 were group-model or staff-model health maintenance organizations (HMOs), 50 were network or independentpractice-association (IPA) HMOs, and 29 were preferred-provider organizations (PPOs). Results. Respondents from all three types of plan said
Private Practice Administrative Costs Influenced by Insurance Payer Mix
Journal of Oncology Practice, 2009
Background: Increased staffing and oncology drug costs per physician, combined with decreased drug revenue, have made private hematology-oncology practices susceptible to increased financial risk. We hypothesized that practices with a higher combined commercial insurance (CCI) mix would experience greater inefficiencies in insurance billing (IB) processes and higher IB administrative costs.
Costs of health care administration in the United States and Canada
New England Journal of Medicine, 2003
A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs. methods For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars. results
Characteristics of Medical Practices in Three Developed Managed Care Markets
Health Services Research, 2005
Objective. To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences. Data Sources/Study Design. Surveys of medical practices in three managed care markets conducted in 2000-2001. Study Design. We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices. Data Collection. A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey. Principal Findings. We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1-125). Most (80.1 percent) medium-(four to nine physicians) and largesize (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas. Conclusions. We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped.
2001
The U.S. office-based physician market has experienced substantial changes in recent years. A growing number of office-based physicians are practicing in large group practices, and vertical integration between hospitals and physician group practices through ownership and contractual relationships has accelerated. Understanding organizational characteristics of office-based physicians and how they interact with quality and costs of care is imperative when discussing policies to promote high-quality and efficient health care delivery. Policymakers need to be knowledgeable of not only the average cost per physician visit for persons in different socio/demographic groups, but also how the characteristics of a practice can impact those costs in order to have a fully informed policy debate.The Agency for Healthcare Research and Quality's (AHRQ) Medical Expenditure Panel Survey (MEPS) supplemental Medical Organizations Survey (MOS) is designed to provide nationally representative estim...
BMC Health Services Research, 2014
Background: The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. Methods: We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, recalculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses.
Fees for uninsured services: a cross-sectional survey of Ontario family physicians
CMAJ Open, 2020
Background: In Canada, family physicians are permitted to charge patient fees for administrative services that are not covered by the public health insurance program, such as prescription renewals outside of an office visit, and completion of forms and sick notes. The objective of this study was to estimate the proportion of Ontario family physicians who offer various fee structures (i.e., à la carte, annual block fees for all uninsured services rendered or no charge) for uninsured administrative services. Methods: This was a cross-sectional telephone survey conducted from April to July 2019 of a random sample of family physicians licensed to practise in Ontario. We excluded physicians with missing contact information or additional specialties, or whose primary practice was outside of Ontario, with a walk-in clinic, with an emergency department, or with an organization that cared for a specific population (e.g., nursing home) or did not provide care (e.g., insurance company). We categorized the geographic location of practices as large urban centre (population > 100 000), small to medium centre (population 1000-99 999) or rural area. We calculated survey weights to account for nonresponse and to ensure representativeness of the sample by geographic area and payment model. Results: Among the 221 physicians who met the inclusion criteria, the telephone was not answered at 42 practices, and the contact information was incorrect for 13, resulting in a sample of 166 physicians (response rate 75.1%). The majority of practices reported that they charged fees for uninsured services: 97 (58.3%, 95% confidence interval [CI] 50.6-65.8) charged à la carte, and 33 (20.3%, 95% CI 14.8-27.3) offered patients the option to pay an annual block fee; 19 (11.4%, 95% CI 7.4-17.3) charged no fees. Fee structures varied by geographic area but not physician payment model. Interpretation: The use of à la carte and annual block fees for uninsured administrative services was commonly reported by a sample of Ontario family physicians. Further research is needed to examine the prevalence of patient payment of fees for uninsured services, patient and physician perceptions of fees, and concordance with regulatory guidance.
Managed care in the doctor's office: has the revolution stalled?
The American journal of managed care, 2001
To assess trends in the involvement of US physicians with managed care. Comparison of data from 2 consecutive rounds of a national survey. Longitudinal data were obtained from the 1996/1997 (n = 12,528) and the 1998/1999 (n = 12,304) rounds of the Community Tracking Study (CTS) Physician Survey, a large, ongoing nationally representative survey of US physicians involved in patient care. Indicators used to assess involvement with managed care included global measures of managed care participation, risk contracting, exposure to financial incentives, and impact of care management tools. Changes in these measures over the 2 study periods are reported. Analyses were conducted for all physicians, as well as for primary care physicians (PCPs) and specialists separately. The percentage of practice revenue derived from managed care increased only modestly over the study period (from 42% to 45%). Mean numbers of managed care contracts per physician increased minimally (from 12 to 13). Trends ...