I just finished catching up on the office billing today. Although I send the daily invoices out to the clearinghouse at the end of every day, the mind-numbing work of downloading the subsequent EOBs and putting that data into the computer so I can then print out and mail statements to patients I save up and do every other month or so. The process in my office is mostly automated (only the Medicare secondary insurances have to be entered by hand) taking about an hour a week to complete, but it is so mentally painful to do, I cannot muster up the energy to do it more regularly.
I have been asked numerous times why I don't outsource this task if it is so painful for me to accomplish, and the answer is twofold. First, economically it does not make sense. If billing takes me an hour a week to complete, that means I spend about 52 hours a year doing billing. Most billing companies charge 6-8% of all collections to do the billing. Last year, my little office collected $280,000. So, I would pay a billing company between $16,800 and $22,400/year or between $323-$430/hour. Even worse, I would still have to provide a significant amount of oversight to make sure everything was done properly. Following this train of thought, I am "getting paid" 5-7X the salary to do the billing than I do to see patients (of course, I am getting off easy, a recent study estimated the cost of collections at $68,000 per physician). The second reason is that I learn a lot about my patients and their economic situation by looking at their bills. I realize who has recently switched to a high deductible plan, who has not paid me in a while, who is only paying $10 at a time, and who never pays. Financial stability may be the most significant factor in health, and doing billing gives me a glimpse through that window.
Still, the whole process is stupid and makes me grumpy. Why is it so hard to get paid for what we do? Why do we need 10,000 codes and 10,000 procedures? Why do I need to know that Insurance A pays for depression, while I need to code it "fatigue" in order for Insurance B to pay? Why are we forced to play these stupid games which dramatically increase cost and does little (other than what I mentioned above) to enhance my relationship with my patients?
Health Care reform is all the rage right now, but the general theory is that we should just somehow make things better by improving what we do and not starting from scratch (which, by the way, is not what the Institutes of Medicine called for in their book, Crossing the Quality Chasm). Reform should start by eliminating this huge cost to primary care practices. I vote to give docs $1/patient/day, allow patients to rate the level of care provided so the practice can continue to improve to meet their needs, and watch as health care costs decrease, quality soars, and primary care docs become less grumpy. The solution is simple, the question is whether anyone is really listening.
John Brady, MD
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