The cost of health care administration: A physician’s frustration

How does a working physician feel about the administrative burdens baked into the U.S. health care system? Kevin Schulman, MD, MBA, is an internal medicine physician and professor of medicine at Stanford University. Here he describes his academic and anecdotal experiences attempting to heal patients, but when health care administration gets in the way.

Medical Economics:As a physician and researcher, do you have any examples of feeling frustrated by administrative burdens in your own work?

Kevin Schulman, MD, MBA:A couple years ago, we looked at the cost of submitting a bill, and for a primary care doctor to submit a bill cost $20.49, and that was almost a decade ago now. When I see patients on clinical service, I'm in hospital medicine. As soon as I see a patient, I have to ask, I get a query about coding-related questions, I have to document all kinds of data that really aren't clinically meaningful, that we use for billing. And I'm fortunate because I'm not dealing with prior auth processes. Patients come to my service from the emergency room. When I discharge them, we get them well taken care of during their stay in the hospital. We come up with a really fabulous follow up plan, and then they're out of network for every follow-up service that we can imagine. And so we're constantly seeing rework, because the health care system doesn't do a good job taking care of these patients. And not a lot of justification for that.