Shedding a Tear for Physician Billing Hassles

Self-employed people — like many freelance healthcare writers, producers, designers and public relations professionals I know and/or work with — don’t have any employees and do their own billing. It’s a bit of a hassle, and no one pays them for their time tracking hours, putting together invoices and sending them out. But they don’t mind doing it. I mean, if they don’t bill for their work, people won’t pay them.

Doctors, though, don’t seem to like billing for their work. In fact, they don’t mind clinical documentation as much as they mind financial documentation. At least according to a recent research letter published in JAMA Internal Medicine. You can download the short though enlightening research letter here.

Seven researchers, all physicians, including well-known single-payer advocates Stephanie Woolhandler, M.D., and David Himmelstein, M.D., wanted to know how much time office-based physicians spent on clinical documentation and whether they liked it or not. Using data from a survey of 1,524 physicians conducted in 2019, here’s what they found out.

Surprisingly, 64.1 percent of the physicians said they were satisfied with their EHR system. Further, 64.5 percent said clinical documentation using their EHR system was easy. The fact that almost two-thirds of office-based doctors are cool with their EHR system is not something you hear about every day. Mostly you hear about doctors hating on their EHR system.

Here’s where it gets more interesting. Nearly six out of 10 doctors — 58.1 percent — disagreed that the amount of time they spend on clinical documentation was appropriate. In other words, they felt they spent too much time on clinical documentation. Why? It’s the billing part, not the clinical part.

Nearly 85 percent of the respondents agreed that clinical documentation solely for billing increases their total documentation time. Further, doctors who participated in accountable care organizations or other pay-for-performance arrangements spent slightly more time on documentation than doctors who didn’t. Physicians in value-based reimbursement arrangements said they spent an average of about two hours a day outside of office hours on clinical documentation compared with about 90 minutes by doctors not in VBR models.

“The large majority of U.S. physicians reported that billing-related tasks exacerbate their documentation burden,” the researchers said.

The researchers’ unspoken agenda, clearly, is to convince us that switching to a government-run single-payer system would dramatically reduce the paperwork burden on doctors, leaving them more time to spend with us care-starved patients.

Be that as it may, what the study is saying is that doctors think they spend too much time billing for their work to get paid, and even more time if they want to get a little bonus. If that’s the case, and we want to keep doctors happy, we should simplify the billing process for them, especially in VBR arrangements. It’s no different than using smart technology to automate the prior authorization process, like we argued in a recent column, “Don’t Hate Me Because I Love Prior Authorization.”

If not, that’s just how it goes. Now I realize billing for an office visit with a patient suspected of having pneumonia is more complicated than billing for a blog post. But physician practices are businesses like any business in any other industry. If they want to get paid, they have to generate and send a bill.

Thanks for reading.