Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System
Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System
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DOI：
10.1001/jama.2017.19148
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发表时间：
2018-02-20
影响因子：
120.7
通讯作者：
Schulman, Kevin A.
中科院分区：
文献类型：
--
作者：
Tseng, Phillip;Kaplan, Robert S.;Schulman, Kevin A.
重要性美国医疗保健系统的行政成本是医疗保健总支出的重要组成部分，其中很大一部分成本可归因于计费和保险相关活动。目的检查和估计与具有经过认证的电子健康记录系统的大型学术医疗保健系统中的医生计费活动相关的管理成本。设计、设置和参与者本研究使用时间驱动的基于活动的成本计算。 2016 年和 2017 年对 27 名卫生系统管理员和 34 名医生进行了采访，以构建流程图，绘制保险索赔通过收入周期管理流程的路径。这些数据用于计算每项主要计费和保险相关活动的成本，并汇总以估计卫生系统处理保险索赔的总成本。暴露 根据与管理人员和医生的访谈，估计执行计费和保险相关活动所需的时间。主要成果和措施 5 种类型患者就诊的估计计费和保险相关成本：初级保健就诊、出院急诊科就诊、普通内科住院患者住院、门诊手术结果 与计费和保险相关的活动的预计处理时间和总成本为，初级保健就诊为 13 分钟，20.49 美元；出院急诊科就诊为 32 分钟，61.54 美元；一般住院治疗为 73 分钟，124.26 美元；门诊手术为 75 分钟，170.40 美元；门诊手术为 100 分钟，215.10 美元。住院手术程序。在这些总数中，医生进行的活动的时间和成本中位数估计为：初级保健就诊为 3 分钟或 6.36 美元，急诊科就诊为 3 分钟或 10.97 美元，一般住院时间为 5 分钟或 13.29 美元，门诊手术为 15 分钟或 51.20 美元，住院手术为 15 分钟或 51.20 美元。在专业收入中，专业计费成本估计占初级保健就诊的 14.5%、急诊科就诊的 25.2%、普通内科住院的 8.0%、门诊外科手术的 13.4% 和住院外科手术的 3.1%。 结论和相关性 在具有经过认证的电子健康记录系统的大型学术医疗保健系统中进行的一项基于时间驱动的活动成本计算研究中，计费和住院的估计成本与保险相关的活动范围从初级保健就诊 20 美元到住院手术 215 美元不等。了解具体的计费和保险相关活动如何影响管理成本可能有助于为减少这些费用的政策解决方案提供信息。
IMPORTANCE Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities.OBJECTIVE To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system.DESIGN, SETTING, AND PARTICIPANTS This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim.EXPOSURES Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians.MAIN OUTCOMES AND MEASURES Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures.RESULTS Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures.CONCLUSIONS AND RELEVANCE In a time-driven activity-based costing study in a large academic health care system with a certified electronic health record system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses.