By NextBestFitCut documentation and billing burden
Simplify billing codes and documentation rules; fewer quality-reporting programs.
Simpler billing under one payer.
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This path
Cut documentation and billing burden
Requires:
Single public payer for everyoneTens of millions of people have no coverageChosenConcrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Simplify billing codes and documentation rules
- Cut quality-reporting programs
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Clinician burnout from paperwork and EHR work
Simpler billing codes, documentation rules, and fewer quality-reporting programs leave more time for patients and reduce the need for billing staff.
- About $1 trillion a year in administrative cost
Simplifying billing and documentation rules reduces the need for billing staff.
What it creates or worsens
- Leaves less complete or useful data
Fewer documentation and quality-reporting requirements leave less data for audits and research.
- Depends on other changes to work
Simplifying billing and documentation depends on payer consolidation.
Who's affected
Who gains
- Doctors, nurses, and other clinicians
- Clinician burnout from paperwork and EHR work: Documentation and insurer paperwork drive burnout and early retirement.
- About $1 trillion a year in administrative cost: Time goes to billing and insurer rules instead of patients.
- People with ongoing or specialist care needs
- Clinician burnout from paperwork and EHR work: Paperwork leaves less face time with clinicians.
- People with employer coverage
- About $1 trillion a year in administrative cost: Premiums pay for the administration.
- Taxpayers and public budgets
- About $1 trillion a year in administrative cost: Public programs pay for it too.
Who loses
- Health administration and software vendors
- Clinician burnout from paperwork and EHR work: They supply the record and billing systems used for administrative work.
- Health insurers, brokers, and their shareholders
- About $1 trillion a year in administrative cost: Insurers, billing firms, and clearinghouses earn from the complexity.
- Insurance and billing workers
- About $1 trillion a year in administrative cost: Their jobs exist because of the complexity.
Where it has been tried
- Taiwan, Canada: Simpler billing reduces physician paperwork.
- Ontario, Canada: A 2011 study estimated annual costs of dealing with payers at US$22,205 per physician in Ontario, versus US$82,975 in the United States.Sources: Health Affairs (2011)