Complexity
Who pays the paperwork tax nobody chose?
The administrative machinery a patient never chose taxes every interaction, from the code on the bill to the plan on the shelf to the record that will not follow you.
Where the physician office day goes
Share of total office-day time, 2016. The two activities shown do not sum to 100 percent. The remainder is other administrative and clinical work.
Read it this way The two bars compare where physician time goes across the whole office day. EHR and desk work at 49.2 percent is nearly double direct patient face time at 27.0 percent. Because the bars don't sum to 100 percent, this cannot be read as a full time budget, only as a comparison between these two activities.
Caveat Single time and motion study of 57 physicians in 4 ambulatory specialties, not a national census. Documentation burden varies by specialty and EHR vendor.
⊞ data table⬇ CSV
| Activity | Percent of office-day time |
|---|---|
| EHR and desk work | 49.2 |
| Direct patient face time | 27 |
Annals of Internal Medicine, Allocation of Physician Time (Sinsky) · 2016 · source
Legislation in play that touches complexity
- To amend the Employee Retirement Income Security Act of 1974, title XXVII of the Public…
- A bill to amend the Employee Retirement Income Security Act of 1974, title XXVII of the…
Counts from Congress.gov + state-legislation trackers, keyword-mapped to this Iron Triangle force. As of 2026-06-18. See the methodology note on the legislation dashboard.
Follow a claim: 1,000 Medicare Advantage prior authorization requests
Flow modeled per 1,000 requests using real published 2023 rates: 6.4 percent denied, 11.7 percent of denials appealed, 81.7 percent of appeals overturned. Widths are those rates applied to a 1,000-request base, not raw counts.
Read it this way Follow the flow left to right: of 1,000 requests, 64 are denied, but only 7.5 of those denials are ever appealed. Among appeals, 6.1 are overturned versus 1.4 upheld, so the widest actionable bar is the 56.5 unappealed denials, not the small appealed slice.
Caveat A modeled illustration of published rates, not a per-request audit trail. Most denials are never appealed, so the overturn share applies only to the small appealed slice.
⊞ data table⬇ CSV
| From | To | Requests per 1,000 |
|---|---|---|
| 1,000 PA requests | Approved | 936 |
| 1,000 PA requests | Denied | 64 |
| Denied | Appealed | 7.5 |
| Denied | Not appealed | 56.5 |
| Appealed | Overturned on appeal | 6.1 |
| Appealed | Denial upheld | 1.4 |
KFF, Medicare Advantage prior authorization determinations, 2023, and HHS OIG appeal data · 2023 · source
Sources & methodology
- JAMIA, descriptive overview of the next-generation HIPAA code sets (Steindel)
- Advances in Wound Care, ICD-9-CM to ICD-10-CM Codes (Cartwright)
- WHO, ICD-11 Fact Sheet
- Annals of Internal Medicine, Allocation of Physician Time in Ambulatory Practice (Sinsky)
- AMA, 2023 Prior Authorization Physician Survey
- KFF, Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023
- HHS OIG, Some MAO Denials of Prior Authorization Requests Raise Concerns (OEI-09-18-00260)
- HHS OIG, MAOs Overturned Nearly All Appealed SNF Admission Denials (OEI-09-24-00331)
- KFF, MA insurers made nearly 53 million prior authorization determinations in 2024
- KFF, Medicare Advantage 2024 Spotlight: First Look
- KFF, Medicare Advantage 2024 county-level plan-count file
- Health Affairs, The Vast Majority of Medicare Part D Beneficiaries Still Don't Choose the Cheapest Plans (Zhou and Zhang)
- Medicare Rights Center, Medicare Advantage Proliferation
- ONC Data Brief No. 71, Interoperable Exchange of Patient Health Information Among US Hospitals, 2023
- ONC, Information Blocking Portal Submissions monthly data
- ONC, US Hospital Participation in Health Information Networks
- ONC, Information Blocking Claims: By the Numbers
Per-chart citation straps carry the in-context detail; this is the full bibliography.