Why is Administrative Burden So Great?

By | November 29, 2019
multitasking physician

As discussed in my post last week, How do we Reduce Healthcare Spending Waste to Improve the Value of Care? I mentioned administrative complexity as a broad category for reducing waste in healthcare. However, before we can implement improvement, we must understand why this category exists. Since the focus is currently on the failure of care delivery, factors like failure of care coordination, overtreatment of low-value care, pricing failure, and fraud and abuse, are mechanisms that increase administrative complexity and create additional costs. This scenario becomes a circular problem. One may argue that the best way to reduce administrative costs is not to have these other issues in the first place.

So, do we address the “chicken,” administrative complexity, or the “egg,” failure of care delivery? Maybe we address them together and consider how these factors are related. For example, if I am a physician that provides care coordination, how does that decrease my administrative burden with a payer? How do payers reward providers with both increased financial incentives, but also administrative incentives? How do we utilize newer technology to monitor fraud and abuse, and can we, as healthcare professionals, do a better job of self-policing

There are creative ways to address many of these domains simultaneously. We need to understand the complexity and realize that the solutions are how we manage the different components. Doing this will require us to address multiple situations that are interdependent simultaneously, like ensuring the involvement of all stakeholders during decision-making, having open conversations, and owning the fact that each party is responsible for a portion of the overall issue are important steps. Very often, we are quick to blame each other. For example, rarely does a physician recognize that providing low-value care is a component of administrative cost.

Another example is precertification which is a result of payers seeing numerous activities occurring that are not evidence-based or have higher value alternatives. Payers then outsource this function to a third party that has an incentive to deny services, which, at times, is appropriate, but other times, is not. How can we stop this spiraling effect? We all need to own our components and have serious, internal conversations that first involves self-reflection and then converse with our colleagues in the various sectors of the healthcare ecosystem.

We must remember that regardless of our position, we are in existence to serve others. The problem at hand is affordability, and we are all cogs in the wheel. We are not just individual components, but interrelated and interdependent. Each of us needs to address our areas while simultaneously working with others to help them solve their concerns. We need to create an environment of trust and verification rather than one of increasing hurdles and punishment. We also must realize that what one calls waste is someone else’s income, and thus we are discussing pay cuts to others and understand that we are all benefiting from the elevated price points. Let us work together towards our shared goal of delivering excellent care at an affordable price.