Impact of administrative complexity in group practices

March 2005 

Project description

As part of Medical Group Management’s (MGMA) ongoing commitment to reducing administrative complexity in group practices, a new research project was conducted regarding the impact that six areas of complexity are having on the day-to-day operations of practices. The purpose of this project was to find examples of how administrative complexity is hurting practices. To address emerging issues, the survey also asks participants to discuss their experiences and opinions of limited clinical authority, conflicting clinical guidelines and measures for potential financial incentives for patient safety, quality and satisfaction.

Project participation

The project focused on groups that overall are considered to be successful. The belief was, if high performing groups are facing issues regarding systemic administrative redundancy and inefficiency as part of their daily routines, the problem must be heightened across the entire landscape of the heath care system. The audience that was focused on for this project included practices represented by the MGMA Board, practices identified as better performers from the Performance and Practices of Successful Medical Groups report, Group Practice Research Network practices, and people who have responded positively (by e-mail) to the simplified concepts. The research project received 94 responses.

Key findings and result highlights

• More than 50 percent of the respondents described insurance product design, payer and provider contracting, billing and payment processes, credential verification and health care fees as areas that represent a major or significant problem in their daily activities
  
  
• When asked if they believe there is opportunity for MGMA to affect areas of administrative complexity, 50 percent or more of the respondents believed that MGMA had an opportunity with average change of success to a good opportunity with a good chance of success to affect payer and provider contracting, billing and payment processes and clinical care management
  
  
• 66.7 percent believed that MGMA had a good opportunity with a good chance to an excellent opportunity to an assured chance to affect change in the area of credential verification
  
  
• Over the past 12-month period, 19.1 percent of the medical groups state that their practice providers have been prevented from exercising clinical authority to order diagnostic procedures or hospitalization due to payers’ requirements for prior approval on a daily basis
  
  
• Over the past 12-month period, 40 percent  of the groups have faced conflicting clinical guidelines (between payers and established medical authorities) that affected care provided to patients in their practice on a daily or monthly basis
  

Final results

Although the research project did collect some quantitative data, the primary goal of the project was to obtain stories from groups that are facing these issues everyday in their practices. Respondents provided many examples of how payers’ requirements for prior approval and conflicting clinical guidelines affected patient care in their practice. They also provided their thoughts and ideas on how MGMA could help with this issue through advocacy and education.

View See a data sheet showing the survey's full results. 

About the Group Practice Research Network

The Group Practice Research Network (GPRN) is a collaboration of leading medical group practices across the United States interested in the development and implementation of research and practice improvement initiatives. GPRN was established by the MGMA Center for Research with funding by a contract from the Agency for Healthcare Research and Quality (AHRQ).

Contact Us

For more information about GPRN, call toll-free 877.275.6462, ext. 880 or e-mail gprn@mgma.com.