Reprint from the
DAILY REPORTER
Columbus, Ohio edition
October 2002
 

Do You Know What Goes on Behind the Scenes at Your Doctor’s Office?

by Kelly Allan and Karen Edwards
For The Daily Reporter

“It is both a very exciting time and a very frustrating time in medicine,” says Dr. Teresa Long, a doctor in preventive medicine in Columbus. “It’s exciting because medicine is becoming more and more of a science. There is new technology and there are new treatments to help us be ever more effective in the art of being a doctor. I guess that is what makes it so frustrating, then, when we have to spend more and more time away from patients, doing the paperwork. As patients well know, there are many such hassles in today’s health-care system.”

A behind-the-scenes glimpse into the practice of a typical physician would show that today’s medical office is driven to a great extent by factors outside of the physician’s control – and outside the patients’ control. “Complying with state and federal laws, regulations and guidelines as well as third-party payer policies means that many hours are spent above and beyond patient care, and at significant expense to the practice,” says Ruth Lander, practice manager with Columbus Oncology Associates. “Most patients haven’t a clue about the amount of control the health-care system has over their lives.”

Here’s a look at what goes on behind the typical office visit:

• When you call for an appointment, your computer record is located, as well as the physical chart itself. Next, the staff will begin to make phone calls to verify the level of benefit with your insurer, and to gather any other necessary information that may be needed. Specialty practices will check to see whether or not referrals are required, and offices that treat patients covered under government payers, such as workers’ compensation, will have to notify the agency prior to your visit.
   
• Before you check in, all of the documentation related to your visit will be collected. If tests had been ordered, the staff will verify that results are in and have been placed with your chart. Phone calls will be made to patients if further information is needed to process a claim properly, so there are no delays at the end of your visit. All this takes people and technology. In an average four-physician office, two staff members will be devoted to make the necessary phone calls and prepare the paperwork prior to your visit.
   
• Following the visit, there are co-pays to collect and claims to file. Many offices will file claims electronically, but occasionally paper claims are filed if supporting documentation needs to be sent with the claim. “The claims forms have become so complex that it takes even an experienced person a lot of time to complete each one,” says Lander.

“To the patient, the whole process is seamless – or at least our goal is to make it smooth for patients,” says Lander. “But doctors are living with an increasing amount of frustration as more and more regulation increases the level of paperwork in a practice.”

The latest regulation with which physicians have had to contend is the Health Insurance Portability and Accountability Act (HIPAA). HIPAA establishes safeguards to protect patient privacy and confidentiality. “Patient privacy has always been important,” says Dwight Scarborough, MD, a Columbus plastic surgeon, “but the HIPAA regulations are cumbersome.” He says he learned recently that it will cost between $5,000 and $10,000 to bring his practice into HIPAA compliance. “It’s another piece of compliance that contributes nothing to our ability to diagnose and treat patients, and it’s costing us a great deal in terms of time with patients and money,” Dr. Scarborough says.

Lander echoes Dr. Scarborough’s concern. “Our physicians understand the need for sensible, practical compliance, but some of the regulations have gone to an extreme.” A practice manager in the Akron area reports that the orthopedic group she works for has been forced to spend $5,000 and considerable time just to relocate the practice’s phone operators to an area where their conversations will not be overheard by patients in the waiting room.

There is some help available, but not every medical practice can afford the latest technology to reduce paperwork. The Ohio State Medical Association, for example, is helping Ohio physicians with a broad range of products and services that can help improve the efficiency of their practices. “Through partnerships with such businesses as Athena Health, a medical practice automation and claims management service, and Cardinal Health/Allegiance, a group purchasing service, OSMA members are able to focus more of their attention on their patients instead of the business side of their practices,” says Carol Mullinax, senior director at OSMA, “but medical offices have become very complex operations, and there are few, inexpensive solutions.”

Without doubt, the practice of medicine has become increasingly complicated. Each visit you make to your doctor sets in motion a range of activity that is both time-consuming and costly. “A common comment we hear from physicians,” says Mullinax, “is that they went into medicine to spend my time focusing on people’s health, and what has happened is that they can’t do that unless they also spend a great deal of time away from patients, doing the paperwork. It’s getting more and more difficult for physicians to do what we, as patients, look to them to do for us.”

Kelly Allan is senior partner of Kelly Allan Associates, Ltd., a Columbus-based business consulting firm. Karen Edwards is communications director for the OSMA.