Oregon Health Authority Director's Message
April 1, 2011 OHA Director's messages on the web
To: All OHA employees
From: Bruce Goldberg, M.D., Director

Serious savings in simplicity

"A little simplification would be the first step toward rational living."
~Eleanor Roosevelt

It's April Fool's Day, and as tempted as I was to write some clever and funny message today, I did not. The truth of the matter is that while I enjoy a good joke I am not great at telling them (or so some say) and writing one takes it to a whole other level.

With that said, dealing with the amount of virtual and actual paperwork it can take to file an insurance claim is like a cruel joke.

It seems no two insurance forms are the same. Precious time is taken up filling out the forms, double-checking those forms, and correcting the forms after the insurance companies reject them because the year was listed as "11" instead of "2011," for example.

No surprise, then, that up to 10 percent of hospital revenue and up to 15 percent of physician revenue goes to these administrative costs.

Providers around the state say something has to change. MaryKaye Brady, administrator of The Women's Clinic in Portland, is a member of the state's Administrative Simplification work group. She sees this problem firsthand.

"We can easily deal with 1,000 different insurance formats in a year," she says.

Reducing and simplifying unnecessary administrative work is an important part of building a health care system for better health, better care and lower costs. To that end, Brady's group developed a set of recommendations, including one that says there should be a single uniform standard for all health care insurance plans, public and private, in Oregon. It seems like a small thing, but it will make a big difference for patients and providers.

Brady's clinic has to employ four people whose job is to bill patients and the myriad health plans that cover them. A finance manager oversees the work of those four "billers." Another staff member's main responsibility is to verify the insurance benefits for surgeries and deliveries.

"Right now, we're doing more and more administrative work -- for fewer and fewer patients," Brady says.

Every step of the way, that's added cost.

That's why the work group's recommendation went forward as part of the Oregon Health Policy Board's legislative package. Now lawmakers are considering a bill that would give the Department of Consumer and Business Affairs the authority to create and administer those standards.

Such a measure would mean a hospital or clinic could use the same form -- preferably an electronic one -- for all of its patients' various public and private insurance plans. Health care providers of all kinds could spend less time filling out forms and more time providing care and education to their patients.

This is the kind of transformation of our health care system that needs to happen if we are to improve quality and reduce waste and inefficiency. Combined with improved efforts toward prevention, better care for people with chronic conditions, and other transformational changes, we continue moving forward with making smart changes to the health care system that will help us all.

And that's no joke.

OHA on the web