TABLE 1.
Variables defining provider‐specific billing and insurance‐related (BIR) costs
| Category | Parameter | Symbol | Mathematical formulation | Assumptions b |
|---|---|---|---|---|
| Provider‐specific parameters dependent on policy reform a | For each provider, the number of features per contract as a fraction of baseline depends on reforms to contractual complexity | X | Baseline value 1 | Varies between 0.5 and 1.2 across scenarios |
| For each provider, the legal burden of administering contracts as a fraction of baseline depends on reforms to legal compliance | L | Baseline value 1 | Varies between 0.5 and 1.2 across scenarios | |
| For each provider, the number of contracts depends on reforms to architectural complexity | N | Whole number, assumed to vary across providers and scenarios. | Median 1000 and interquartile range [100,10000] at baseline | |
| Provider‐specific a | Clinical documentation cost per visit | CD | Provider‐specific per‐visit cost of clinician time spent on documenting exclusively for the purpose of billing and administration. | Table S1 |
| Nonclinical documentation cost per visit | ND | Provider‐specific per‐visit cost of nonclinician time spent on documenting exclusively for the purpose of billing and administration. | Table S1 | |
| Fraction of contracts that are negotiated or renegotiated each year | F | Default value 0.25, set to either 0.25 or 1 across scenarios | Set to either 0.25 or 1 across scenarios | |
| Marginal cost of per‐visit clinical documentation as a linear multiple of the complexity and legal burden of the provider's contracts | aCD | CD = aCD*X*L | May vary arbitrarily across providers | |
| Marginal cost of nonclinical documentation as a linear multiple of the complexity, legal burden, and number of the provider's contracts | aNC | NC = aND*X*L*N | May vary arbitrarily across providers | |
| Fixed annual contracting costs as a linear multiple of the complexity, legal burden, number, and fraction re‐negotiated annually of the provider's contracts | aFC | FC = aFC*X*L*N*F | May vary arbitrarily across providers | |
| Number of visits | V | Assumed fixed for each provider across scenarios | May vary arbitrarily across providers | |
| Ratio of per‐visit clinical to nonclinical documentation costs | r | CD/ND = a1/(a2N) | Table S1 | |
| Ratio of fixed to variable costs | s | FC/(v*VC) = a3NF/(v(a1 + a2NF)) | Table S1 |
a
Each of the provider‐specific variables differs for each provider and should technically be denoted with a subscript i to correspond to providers of type i, for example, ai,CD. We omit these subscripts since the relationships between the variables are identical across providers.