You know all those bad jokes about how doctors are always on the golf course. Wrong sport. Turns out they are jumping through hoops—$31 billion worth of hoops.

Two new studies released this week online by Health Affairs examine how health care providers, particularly physician practices, interact with insurers. One study found that doctors personally spend the equivalent of three full weeks a year on billing and related insurance information. The overall cost to their practices (their time as well as other medical and clerical personnel) was about $31 billion a year (in 2006)—which as study author Larry Casalino noted, was about six times what we spent at the time on the State Children's Health Insurance Program and nearly 7 percent of total national expenses on physician and clinical services. Primary care practices spent more time on these administrative tasks than specialists. Very little of the data—only about two hours a year for the doctor—pertained to quality data.

The second study looked at the billing and insurance-related activities at one large multi-site, multi-specialty California group practice. The cost (in physician and clerical time) turned out to be $85,276 per physician, or 10 percent of operating revenue. (And that excluded the time the doctors spent recording procedure and diagnosis codes). And this California practice isn't bogged down in paper; they already use electronic medical records for both clinical and billing data. (Some older studies, before medicine began its slow and not always so steady migration to Health IT, showed even more time and money spent on administration in the days of pure paper.)

Neither article, both of which were funded by Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization (HCFO) Initiative and The Commonwealth Fund, argues that every minute or every dollar was wasted. There will be some administrative work in any health care system we create, reform or imagine. And, sometimes, Casalino said, insurers have sound evidence-based reasons for preferring that a doctor tries drug or procedure X before drug or procedure Y which costs 10 times as much and doesn't seem to do a better job. But if we're looking to find savings in health care (and yes, we most certainly are) the administrative burden, has to be one place to start. Casalino and his co-authors noted some steps  toward simplification have already been taken.. The California authors added:

Standardization of benefit plans and billing procedures appears to offer great potential to decrease complexity and thus billing/insurance costs. However, to yield efficiencies, such standardization must be strict. Our respondents reported that even with standard coding and claims guidelines, the lack of consistency and transparency in payers' interpretation of those guidelines requires considerable resources to manage.

As we look for ways to stem the unsustainable rise in health care spending, maybe this is one place to begin. A well-regulated insurance market, with clear rules, greater transparency, and intelligible benefit packages, will help patients and doctors alike. It may even give them some time to play golf.