Managing Paperwork, Part 1: Low-Tech Solutions

Just mentioning the "P" word to healthcare professionals is likely to induce a shudder. Paperwork and other administrative tasks have become an increasingly heavy burden for doctors, nurses, and the healthcare industry in general. In the United States, the advent of managed care and increasing numbers of state and federal regulations are the main causes for the proliferation of paperwork.

The Problem(s)

According to an article published in ADVANCE, 20¢ of every dollar spent on healthcare in America is swallowed up by administrative costs. Information published on the National Center for Policy Analysis website states that administrative costs are estimated to be $1,000 per patient. Much of the paperwork is generated by insurance companies, and $13 billion are spent on processing insurance billing claims. The American healthcare industry employs three million clerks and managers, which is nearly four times the number of practicing doctors.

Many doctors are starting to feel the strain. According to a June 14, 2007 news item published in the Ventura County Star, the majority of Californian doctors surveyed felt that the burden of administrative tasks was negatively affecting their patient care. Eighty percent of the doctors reported that they were not able to spend "as much time with patients as [they] consider necessary to provide good care," and 76% of respondents reported that the "limits and restrictions that insurance companies place on doctors" were a major problem.

In 2001, the Health Care Paperwork Reduction and Fraud Prevention Act was introduced to Congress. To put the paperwork problem into concrete terms, US Department of Health and Human Services secretary Tommy Thompson gathered all the Medicare cost reports generated by one hospital over three months – and created a teetering stack four feet (1.2 meters) high! Unfortunately, the Paperwork Reduction Act never made it into law, and the status quo seems unlikely to change in the near future.

However onerous it may be, there are good reasons for finishing your paperwork in a timely, accurate, and legible fashion. Since paperwork is primarily about communicating necessary treatment information, perfect paperwork can save time, money, and even lives. Many patients receive care from multiple doctors, nurses, and other practitioners, and it is vital that all healthcare professionals immediately record their observations and actions in the patient charts. According to an article published in the January-February, 2002 issue of Physician Executive, paperwork errors accounted for 60% of all adverse drug events. Wrong-sided surgery, where a healthy limb or organ is erroneously removed rather than the diseased one, is another dire result of communication lapses. The same article calculated that prescription and administration mistakes might cost a 700-bed hospital $3 million a year. Even putting off your paperwork has financial repercussions. Since the practice does not get paid until the charts and charges are filed, one doctor estimated that tardy paperwork submission in his group of 40 physicians "represents a lost cash-flow opportunity of $400,000."

Low-Tech Solutions

Here are some practical suggestions on how to turn that teetering mountain of paper into a manageable molehill:

1. Sort it according to urgency,
2. Highlight important aspects, and
3. Attach any relevant files or information.

1. "Action required" (e.g., insurance claim submissions, requests for consultations),
2. "For your information" (e.g., medical journals, meeting minutes), and
3. "Recycling bin" (e.g., invitations to conferences you don't plant to attend, drug and medical product advertisements).

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