When doctors are overburdened with paperwork, patient care suffers, UNM study finds

When health care providers are burdened with excessive insurance paperwork, patient care and clinician well-being suffer, according to a new report from the University of New Mexico’s Center for Social Policy.

The study found what most providers already know, said one of its authors, UNM professor Melanie Sonntag: The health care billing system is complex, time-intensive and robs clinicians of hours that could be spent with patients.

Sonntag and co-author Gabriel Sanchez, both of the UNM Center for Social Policy, interviewed clinicians and billing staff across the state, 77.4% of whom said they work on billing tasks every day. Physicians reported spending around three to four hours per week on health care billing — either coding and charting patient interactions for billing and reimbursement, or directly in contact with an insurance representative to rectify an administrative wrinkle.

One clinician who participated in the study reported spending 10 to 15 minutes on documentation for every 15 to 20 minutes spent with a patient.

“An enormous, extreme amount of our time is spent on all of those things, on documenting, on billing, on charting, on things that are not direct face-to-face patient care,” said Dr. Kristy Riniker, vice president of the New Mexico Academy of Family Physicians and a family doctor in Rio Rancho.

Riniker estimates she spends two and a half hours per day on paperwork. She has to adjust a patient’s care because insurance won’t pay for something they need “on a daily basis,” she said.

In an already difficult health care landscape, excessive billing requirements, combined with costly medical malpractice policies, compound the stressors on overburdened providers in New Mexico, advocates say.

“I do think that as our health care system has evolved, through Medicare and through commercial insurers, that we have turned our physicians into data entry folks,” said Troy Clark, president and CEO of the New Mexico Hospital Association.

The UNM study, commissioned by the Legislative Council Service, is one of the first times a state has collected detailed information on health payment systems from those who experience it firsthand, according to Mary Feldblum, a contributor to the report.

“It’s driving physicians crazy and nurses crazy, and it should drive hospitals crazy,” said Feldblum, executive director of the Health Security for New Mexicans Campaign, a health care reform advocacy group.

Though insurance issues were common throughout the state, the report found billing complications were most evident in rural clinics serving low-income communities that rely on Medicaid and Medicare and its low reimbursement rates.

Staff at rural clinics reported spending much of their time educating patients about the limits of their insurance plans, and patients in rural areas often have to travel long distances for an in-network laboratory or pharmacy, the report said.

“We already have a health care worker shortage, and there are issues beyond billing and claims that are incredibly pronounced in rural parts of the state that are exacerbated by the issues of administrative complexity,” Sonntag said.

An insurance hurdle anyone who has visited a doctor in the past few decades is probably woefully familiar with is prior authorization — the requirement that a provider obtain approval from a patient’s insurance before treatment.

Prior authorization is a bane for both providers and patients, survey respondents said. Approval from insurance companies can take weeks or months, and may cause further delays to care in a state like New Mexico, where the wait to see a specialist could span months, the report found.

Nurses surveyed reported spending as much as four hours a day attempting to get prior authorization from insurance, either using a web portal or on hold via an automated call tree.

“This is a problem across the country. Of course, it always feels more intense in New Mexico because we have so many other issues impacting health care here,” said Annie Jung, executive director of the New Mexico Medical Society.

Doctors nationwide complete an average of 39 prior authorization requests per week, and physicians and their staff spend an average of 13 hours completing those requests weekly, according to an American Medical Association survey.

And if a request is approved, there’s always a chance the insurance company could retroactively deny it after the treatment was performed and the money was already disbursed.

Even if the reason for the denial is because of an error on the insurance company’s end, insurance will “claw back” the money from a provider after it was already sent, sometimes months or a year after the procedure was completed or the medicine given, Jung said.

“I can’t think of any other industry where that would be allowed,” she said.

Providers are attempting to solve some of the paperwork problems on their own — many doctors are turning to artificial intelligence in the form of ambient listening technologies that transcribe and record conversations with patients to decrease some of the note-taking volume, Clark said.

New Mexico’s lawmakers have made some attempts to reform the state’s prior authorization system. Senate Bill 188, signed into law by Gov. Michelle Lujan Grisham in 2019, sought to limit the amount of time insurance companies could take to grant prior authorization approval. This July, a new state law banned prior authorization requirements for certain medications for cancer, autoimmune or substance abuse disorders, but advocates are pushing for more.

Last month, Sonntag and Sanchez presented their findings to the state’s Legislative Health and Human Services Committee, and Sonntag said she’s hopeful lawmakers are ready to enact change.

“Ultimately, there does seem to be interest in changing things,” she said. “The important part is just that it actually happens.”