By Stephen B. Kemble, M.D.
Honolulu Star-Advertiser, Nov. 6, 2014
Health care in the U.S. suffers from severe over-management.
Recent studies have documented high administrative burdens for American doctors and hospitals. The average U.S. physician spends a sixth of their time on administrative tasks that are not integral to patient care, and this is worst for psychiatrists, internists, and family practitioners – the very specialties for which we have the worst shortages.
Administrative costs for U.S. doctors are about four times those of countries with simpler, universal health care systems.
U.S. hospitals also spend 25 percent of their budgets on administration, much higher than in any other country and twice as high as countries like Canada and Scotland.
Since the introduction of managed care in the 1990s, the number or doctors in the U.S. has about doubled, while the number of administrators has increased more than tenfold, to the point that there are now far more administrators than doctors.
Spurred by the Affordable Care Act, doctors and hospitals are reorganizing into large systems, and hospitals and insurance plans are buying up physician practices all over the mainland, supposedly to improve care coordination and efficiency of care. Actual results are showing the opposite. Large systems bring higher administrative burdens for doctors and raise the total cost of care.
Pay-for-performance is the latest scheme to micromanage doctors, but the complexity of health care means the validity of “quality” measures is very low, and financial incentives reward the wrong things and encourage gaming of documentation to satisfy “metrics.”
Conscientious doctors who knows their patients will always know far more about quality of care for individual patients than a health plan administrator with “metrics” from claims and electronic health records. Physicians are increasingly demoralized by micromanagement from clueless administrators, harming actual quality of care.
Hawaii’s health transformation initiative has so far been focused on developing “Accountable Care Organizations” and implementing pay-for-performance schemes, relying on federal health care innovation grants. These efforts are getting us nowhere in the quest for the “Triple Aim” goals of improved quality of care, improved population health, and reduced cost. Once the grants run out, we are left with administratively complex and costly reforms that can’t work in practice.
I hope our next governor will realize the futility of this approach and support reforms that reduce administrative burdens on doctors and empower them to do what they were trained to do – manage the care of their patients based on their professional training balanced with specific knowledge of each patient’s unique illnesses and circumstances.
Instead of pay-for-performance, physician pay should be incentive-neutral, freeing doctors to focus on the best interest of their patients.
Relief from administrative burdens will also help recruit and retain doctors, making it easier for them to practice in underserved specialties and locations.
If we want to achieve the Triple Aims, we need to assure care for everyone in the most cost-effective settings, simplify and streamline administration, and use administrative savings – not restrictions on care – to reduce the prices paid for health care.
Dr. Stephen B. Kemble is assistant clinical professor of medicine at the John A. Burns School of Medicine.