AAFP passes resolution seeking reimbursement for paperwork

Physician practices being asked to complete administrative paperwork for no compensation isn't new, but in many doctors' eyes, the load has gotten much worse.

That's why the American Academy of Family Physicians is poised to consider how third-party payers can be persuaded to reimburse doctors for a wide range of tasks their practices are typically doing without extra fees. This work ranges from filling out insurance forms to writing new prescriptions when drug formularies change.

The AAFP's congress of delegates, meeting in October in Orlando, Fla., passed a resolution calling for the organization to help its members understand "how to bill and collect for clinical and administrative services not covered by insurance, and advocate with public and private insurers to recognize the value of, and to appropriately pay for, these services."

The academy also voted to affirm family physicians' right to receive fair reimbursements when they provide management and coordination of complex hospital care concurrently with other doctors.

Mary Frank, MD, president of the AAFP, said the resolution on administrative paperwork represented a boiling over of pent-up unhappiness or "a cumulative effect of what members see as unfair mandates."

"The members became testy," she said. "They're having all this extra paperwork added on to their workload and their workday. They're saying, 'I never needed to do this and this and this and this, and now I'm doing it.' "

Ways to implement the resolution probably will be considered by the academy's Commission on Health Care Services, which is scheduled to meet in January 2005, Dr. Frank said. In general, the objective is to get insurers and not patients to pay doctors for administrative chores, she said. Generally, Medicare and private plans argue that the cost of paperwork is built into what they pay physicians

One possibility would be for doctors to receive a "care management fee," a small supplemental sum paid by insurers periodically to help compensate for administrative tasks associated with patients with complex medical problems, Dr. Frank said.

Under AMA policy, physicians should be able to set fees that are not excessive, and doctors should do simple insurance tasks free of charge but are entitled to be paid for complicated administrative services required by payers.

The onslaught of administrative paperwork handled by doctors is surely one source of "the growing frustration with the practice of medicine" and represents "a difficult challenge for doctors," said John C. Nelson, MD, MPH, president of the AMA and an obstetrician-gynecologist from Salt Lake City.

"The AAFP is saying pay us for what we do," he said. "We think we should be paid for what we do. We don't think we should do all the work and the [insurance] executives should take home all the pay."

Though insurance companies might not agree, he said, they can probably afford to pay medical practices for more administrative tasks if they tighten up on their own overhead expenditures and keep less for profits.

The AAFP delegates also passed a resolution calling for changes in the health care payment system that would give family physicians the ability to be reimbursed for managing the care of hospitalized patients who also are treated by specialists.

Family physicians helping to treat a patient in the hospital are commonly denied payment by insurers if they submit bills using the same CPT code that specialists use in billing for the same patient, Dr. Frank said.

Family physicians should be eligible for that compensation when they oversee the coordination of the patient's care instead of a hospitalist, she said.

"When the hospitalist is assuming the role of care coordinator and caregiver, he or she should be reimbursed," Dr. Frank said. "When the [family physician] is assuming that role, there should also be appropriate reimbursement."