Recent John Hopkins Study Shows Quality Reporting Cost of Over $5 Million in One Year

Sarasota, FL (WorkersCompensation.com) – Administrative tasks and reporting are taking up a bigger portion of healthcare expenditures. According to a 2018 study, researchers estimated the costs of billing and insurance-related duties at around 3 to 25 percent of professional revenue.

Recent reports have estimated that physicians spend around 45 percent of their time on administrative duties instead of seeing patients. Leading experts estimate that around 16 hours a week are spent on prior authorization duties alone. The primary purpose of prior authorizations is to act as a gateway on cost and medical necessity.

One of the drivers for the requirements for prior authorizations is quality metrics. CMS, as well as insurance companies use the data of clinical outcomes, complications, and billing trends to create new regulations and coverage policies, authorization requirements, and to create alternative payment models. As a result, providers are tasked with also tracking the same data to stay abreast of requirements, sometimes at an enormous cost.

Researchers from Johns Hopkins University School of Medicine in Baltimore, Maryland analyzed the costs involved in measuring and reporting quality metric data for an acute care hospital, excluding any costs associated with quality improvement implementation. The researchers performed a retrospective cost study at the Johns Hopkins Hospital, interviewing staff that had been part of the reporting processes for the 2018 calendar year. The researchers identified 162 unique metrics of which 96 were claims-based, and 107 were related to outcomes and patient safety.

The researchers found that the preparation and reporting of the data metrics required an estimated 108,478 person-hours, and at estimated personnel cost of $5,038,218.28, adjusted for 2022 rates. Additionally, the required vendors fees totaled $602,730.66.

Broken out by type of metric, the cost for reporting on the 96 claims metrics totaled $37,553.58 per metric per year. The cost for reporting the clinical metrics varied by location of the data. Data that had to be pulled from the charts totaled $33, 871.30 per metric per year. Electronic metrics required less work and costs, totaling $1,901.58 per metric per year.

The researchers found that the claims-based metrics were the most difficult to report on, requiring more time and staff.

Given the recent results of OIG claims audits, the findings of the study are not a surprise for those that work in healthcare. While the goal of the federal legislation has been to improve healthcare, lower costs, and streamline processes, this study is a great example of unintended consequences.

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