Health Affairs, doi: 10.1377/hlthaff.28.4.w544 (Published online May 14, 2009) © 2009 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Peering Into The Black Box: Billing And Insurance Activities In A Medical Group

¹ Julie Sakowski is a senior health services researcher at the Sutter Institute for Research and Education in San Francisco, California, and an assistant clinical professor, Department of Clinical Pharmacy, at the University of California, San Francisco (UCSF).
² Jeffrey Newman is director of the Sutter Institute and an adjunct professor in the Institute of Health and Aging, UCSF.
³ James Kahn is a professor of health policy and epidemiology, UCSF.
⁴ Rick Kronick is a professor in the Department of Family and Preventive Medicine, University of California, San Diego, in La Jolla.
⁵ Hal Luft is director of the Palo Alto Medical Foundation Research Institute in Palo Alto, California and Caldwell B. Esselstyn Professor Emeritus of Health Economics and Health Policy at UCSF.

^*Corresponding author.

Abstract

Billing and insurance-related functions have been reported to consume 14 percent of medical group revenue, but little is known about the costs associated with performing specific activities. We conducted semistructured interviews, observed work flows, analyzed department budgets, and surveyed clinicians to evaluate these activities at a large multispecialty medical group. We identified 0.67 nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions per FTE physician. In addition, clinicians spent more than thirty-five minutes per day performing these tasks. The cost to medical groups, including clinicians' time, was at least $85,276 per FTE physician (10 percent of revenue). Health Affairs 28, no. 4 (2009): w544-w554 (published online 14 May 2009; 10.1377/hlthaff.28.4.w544)]

Key Words: Business Of Health, Consumer Issues, Physicians, Health Spending

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