Dealing with billing, care preauthorization requests and other health plan communications costs the typical U.S. physician about 4 times as much as it costs a typical physician in Ontario.

A team of researchers led by Dante Morra of the University of Toronto has published that finding in an article in the August edition of Health Affairs, a health finance and delivery journal.

The researchers have based their findings on a survey of about 423 Canadian family physicians, specialists and managers of practices with 3 or more doctors, and a comparison with results from a similar survey of U.S. physicians and group practice managers that was conducted in 2009.

The average amount of time spent dealing with health plans was about 3.4 hours per week for U.S. doctors and 2.2 hours per week for doctors in Ontario.

When the researchers looked at nurses and clerical staffers as well as physicians, the difference was bigger: the amount of time that physicians, nurses and clerical staffers spend dealing with health plans averaged about 77 hours per week at U.S. practices and about 21 hours per week at Ontario practices.

The researchers found that senior group practice administrators also spent some time dealing with health plans.

The total value of the time spent by physicians, nurses, clerical staffers and senior administrators on health plan interactions averaged about $83,000 per physician for U.S. practices and about $20,000 per physician for Ontario practices, the researchers say.

Even if the Ontario practices were paying U.S. salaries and had the same mix of specialties, the cost of their interactions with health plans would still be only about $22,000 per physician per year, the researchers found.

The researchers note that the time spent on health plan interactions may not necessarily be wasted time. Some of the health plan interactions may produce benefits, by, for example, reducing health care costs or increasing the quality of care, the researchers write.

But policymakers and others should be looking for ways that health plans can make interactions with U.S. practices more efficient, the researchers write.

- Allison Bell

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