Doctors Say Patient Needs are Buried in Paperwork
January 23, 2011
By Kevin O’Connor
RUTLAND — Middlebury’s Dr. Jack Mayer knows that most patients want health care reform to cut rising prices. But he, along with a growing group of Vermont medical providers, hopes to point a scalpel at piles of related paperwork.
Back in 1976 when Mayer opened his first pediatric office in the tiny northernmost town of Enosburg Falls, the Bronx native often bartered his services for eggs, firewood or knitted afghans.
In a larger community and practice 35 years later, Mayer now works with two fellow physicians, a nurse practitioner and two full-time billing clerks who process claims for more than 200 insurance plans.
“Every company has its own paperwork, payment schedules and policies about what it will cover,” says Mayer, who notes that such overhead eats upward of 30 percent of U.S. medical expenses. “The administrative costs of my practice are enormous and don’t go toward improving health or patient care.”
Mayer isn’t alone in his assessment. So many Vermont medical professionals have similar concerns, the Legislature — now contemplating several plans to change the state’s health care system — will hold a public hearing in Montpelier this week to receive their testimony.
“What I hear from all my colleagues is, ‘For every hour I put into clinical care, I put another into paperwork,’” says Dr. Deborah Richter, a Cambridge physician. “They can’t give the care that patients need because of these obstacles.”
Richter is president of the Vermont Health Care for All campaign, which for almost a decade has pushed for what a state consultant proposed last week: a single-payer system to provide medical coverage to all residents.
Richter wasn’t sure if her peers would respond when the Legislature — welcoming public comment through Feb. 3 — invited them to speak Thursday from noon to 2 p.m. at the Statehouse. So far 50 colleagues have confirmed they’ll be there.
“These are busy doctors,” she says, “but they’re willing to talk.”
Nothing but billing
Take Dr. Adam Sorscher, an 18-year primary care physician who juggles work at Central Vermont Medical Center in Berlin, Dartmouth-Hitchcock Medical Center in Lebanon, N.H., (the New Hampshire hospital is Vermont’s second-largest health care provider) and the Good Neighbor Health Clinic in White River Junction. He finds problems wherever he goes.
“I see people at the clinic who have neglected preventive care because of the high cost,” Sorscher says, “and then we have to provide therapies that are more expensive and wouldn’t have been necessary if the health care system was better organized.”
Or consider Dr. William Eichner, an eye specialist who opened his Middlebury practice in 1976 and has added branches in Rutland and Ticonderoga, N.Y. To do so, he has increased his staff to 20 — three of whom focus solely on financial paperwork.
“They don’t greet patients, they don’t handle charts,” the ophthalmologist says. “They do nothing but handle billing and insurance claims.”
That frustrates more and more doctors. Richter points to a 2006 survey she sent to Vermont’s 840 primary care physicians. Of the 300 who responded, four out of five agreed with such statements as “Unnecessary paperwork increasingly is taking away more of my time from my patients” and “I don’t find the intrusion from outside managers and companies helpful.”
Providers say the resulting costs are pricing out more and more patients.
“I feel ashamed we’re the last developed country in the world not to have universal health care,” Eichner says. “I feel a moral imperative that everyone has access and that it be affordable.”
‘Have to kowtow’
Burlington’s Dr. Peggy Carey recalls when, lacking health insurance in her 20s, she was diagnosed with diabetes. Inspired by a nutrition course she took to deal with her diagnosis, she went to medical school and now works as a family doctor in a group practice.
“I wanted to change the system,” says the former English teacher turned 19-year physician.
Carey belongs to the doctor-led Vermont for Single Payer campaign and Physicians for a National Health Program. But she fights her biggest battles inside her practice.
“The majority of the paperwork that comes to me is not in reference to patient care,” she says, “but to what insurance plans allow or don’t allow.”
The problem isn’t limited to physical health. Psychiatrist Dr. Alice Silverman moved to St. Johnsbury two decades ago because the state’s rural Northeast Kingdom lacked enough mental health workers. Today she’s president of the Vermont Psychiatric Association — yet remains one of her region’s few resources.
“I’ve had a waiting list for years,” she says, “and there’s no one else I can refer to.”
Even so, insurance hurdles keep more people out of Silverman’s office.
“I may have someone who’s suicidal, but insurers say they have to see a provider in network, even when there is no one in network,” she says. “In psychiatry, people feel embarrassed enough — to have to call and get approval is a real obstacle. I spend 30 percent of my time trying to get care authorized.”
Burlington’s Dr. Joe Lasek, another psychiatrist, can relate. He works at the Howard Center, a private, nonprofit human service agency that takes care of his billing paperwork. But he still must tackle other insurance issues.
“If I try to get diagnostic tests or follow-up treatment for my patients, insurance companies can say no,” he says. “I have sick and sometimes suicidal patients who aren’t getting care.”
Such problems are keeping other professionals out of the business. Lasek’s wife has a medical degree.
“One of the main reasons she’s not practicing is these hassles,” her husband says. “I have other friends who are pulling back their hours or retraining in another field.”
Berlin’s Dr. Stuart Williams says a growing number of his colleagues support change. The 30-year practitioner is on the board of the Vermont Academy of Family Physicians, which found that a majority of members surveyed favor a single-payer system.
“It seems that physicians have capitulated responsibility to insurers,” Williams says. “We’ve become second tier when we recommend a procedure to a patient and have to kowtow to prior approval and paperwork to put that care in place.”
Doctors may agree on the problem, but they aren’t united on the solution. While the Vermont Psychiatric Association has endorsed a single-payer plan, Williams — a member of the council of the Vermont Medical Society — says other medical specialists haven’t voiced a formal position.
Single-payer supporters believe state involvement will eliminate private insurers’ profit motives for questioning care. But they know that skeptics fear government interference.
“People worry that outsiders would be making decisions,” Sorscher says, “but important decisions already are being made by corporate entities.”
Proponents also point to the federal Medicare health insurance program, which, even with its own funding problems, estimates its overhead to be about 3 percent — a tenth of that of private insurers.
“It works for everyone over 65,” Eichner says. “Why not make it universal?”
Back in Middlebury, Mayer says physicians of all political opinions may complain about paperwork, but ultimately they’re most concerned about patients.
“If we as a nation take as a basic premise that health care should be a universal right of all citizens, equally, like Medicare, we will figure out an equitable way to pay for that,” he says. “My decision-making is impacted when I have to think about a person’s personal economics and how much some treatment will cost them. It’s just not fair for those financial considerations to get between me and the care my pediatric patients deserve.”