As professionals dedicated to improving patient outcomes, we want to spend as much time as possible helping patients. But more and more, we spend our time doing paperwork or electronic administrative work.

Medical administrative costs in the United States significantly exceed those in other developed nations. An article comparing hospital administrative costs among eight developed nations found that administrative costs in the United States exceeded all others and accounted for 25% of total spending in United States hospitals.^[1] A study by Casalino et al^[2] estimated that when the amount of time spent interacting with insurance companies was converted into dollars, the national time cost estimate to practices was at least $23–$31 billion each year. It also estimated that nursing staff spends an average of 13.1 hours per week on authorizations.

As administrative costs have risen, physician reimbursement has declined. In addition, physician compensation as a percentage of health care cost in the United States is 8.4%, among the lowest of major Western nations compared to Germany's 15% and France's 11%.

“Be sure to also take advantage of the wealth of practice management resources that we provide.”

Physician burnout secondary to practice management challenges has also become a major health care crisis. Multiple factors have been shown to drive physician burnout,^[3] many of which are associated with practice management. Linzer et al^[4–5] defined the primary factor associated with physician satisfaction as the development of patient relationships—independent of compensation.

All these statistics were part of a presentation made to the ASRA Board of Directors by Board member David Provenzano, MD, during its fall strategic planning session. Dr. Provenzano was requesting funding for development of a full-service practice management resource center, which would establish a portfolio that allowed for continued and advanced learning through annual meetings, satellite meetings, website material, newsletter articles, and webcasts. The hope is that ASRA can help providers spend more time caring for patients and less time struggling with administrative burdens. In support of leaders with well-defined skills in practice management, we hope to combat the trend toward physicians being detached, with fewer resources available for the core missions of patient care, research, and education. I am pleased to report that the project was approved by the Board of Directors, and the Practice Management Committee is now charged with developing the resource center with a planned 2018 rollout.

In recent years, ASRA has increasingly been allocating resources toward practice management. We provided comments and feedback to the Centers for Medicaid and Medicare Services (CMS) regarding the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. We've also created an educational curriculum at our annual meetings focused on practice management issues. This past fall, we worked with the American Society of Anesthesiologists to develop new quality measures through the Acute and Chronic Pain Technical Expert Panel. We are proud to say that CMS has approved the Anesthesia Quality Institute (AQI) National Anesthesia Clinical Outcomes Registry (NACOR) as a Qualified Registry and Qualified Clinical Data Registry (QCDR) for 2018 MIPS reporting and has approved the 2018 menu of QCDR measures, posted here. ASRA members can participate in AQI NACOR at a discounted rate by going to https://www.aqihq.org/send-me-info.aspx.

ASRA will continue this focus in 2018 with proposed resources, including fact sheets on recommended quality measures for MIPS, a checklist on how to earn 15 points to be neutral (the minimum for 2018 is 15 points), and a “How I Do It” podcast on implementing MACRA, focused on small- and medium-sized practices.

We are also very proud to report that ASRA has earned a seat on the American Medical Association's Specialty and Service Society. This allows ASRA to move one step closer to discussions about current procedural terminology and related conversations.

Although you may often attend our meetings, read our publications, or visit our website with the goal of learning the latest research and developing your practical skills, be sure to also take advantage of the wealth of practice management resources that we provide. This aspect of your practice is becoming increasingly important to ensure that you have the skills to be successful in practice and ultimately provide the best care for your patients.

Acknowledgment

Thank you to David Provenzano, MD, for contributing to this article.

References

1. Himmelstein DU, Jun M, Busse R, et al. A comparison of hospital administrative costs in eight nations: US costs exceed all others by far. Health Aff (Millwood). 2014;33(9):1586–1594.
2. Casalino LP, Nicholson S, Gans DN, et al. What does it cost physician practices to interact with health insurance plans? Health Aff (Millwood). 2009;28(4):w533–543.
3. Rothenberger DA. Physician burnout and well-being: a systematic review and framework for action. Dis Colon Rectum. 2017;60(6):567–576.
4. Linzer M, Poplau S, Babbott S, et al. Worklife and wellness in academic general internal medicine: results from a national survey. J Gen Intern Med. 2016;31(9):1004–1010.
5. Linzer M, Manwell LB, Williams ES, et al. Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009;151(1):28–36, w6–9.