The Cost of Manual Back-Office Work in Clinics: A Statistics Roundup

$950 billion (about 25% of total US healthcare spending in 2019)

Administrative expenses account for roughly 15% to 25% of total US healthcare spending, with a 2019 estimate placing total administrative spending at $950 billion.

$83 billion annually; providers bear 97% of the cost

The US medical industry spends $83 billion annually in staff time on routine administrative transactions between providers and health plans, and providers absorb 97% of those costs.

14% year-over-year increase; about $21 billion in added cost

Provider time spent on healthcare administrative processes increased 14% on average in 2023, adding roughly $21 billion in costs to the healthcare system in a single year.

$258 billion avoided; $21 billion remaining opportunity

US healthcare avoided an estimated $258 billion in administrative costs in 2024 through electronic transactions and automation, yet a $21 billion savings opportunity remains from fully automating manual workflows.

92% of medical groups reported higher operating costs in 2024

92% of medical group leaders reported their practice's operating expenses increased in 2024 versus 2023, with staffing costs cited as the leading driver.

7.3 hours per week on admin; 57.8-hour total physician workweek

In 2024, physicians spent an average of 7.3 hours per week on administrative tasks, including prior authorization, insurance forms, and meetings, out of a total 57.8-hour workweek.

Nearly 15% of claims to private payers initially denied

Nearly 15% of all medical claims submitted to private payers are initially denied.

$57.23 per denied claim (up from $43.84 in 2022); 30% increase

The administrative cost to rework a single denied claim rose from $43.84 in 2022 to $57.23 in 2023, a 30% jump in one year.

70% of denials overturned; about $18 billion in potentially wasted spend (2023)

70% of denied claims are ultimately overturned, meaning roughly $18 billion of the $25.7 billion providers spent fighting denials in 2023 was potentially wasted on claims that should have been paid in the first place.

19% in-network denial rate; under 1% of denials appealed

ACA Marketplace insurers denied 19% of in-network claims in 2024, with administrative reasons accounting for 25% of all denials, and fewer than 1% of denied claims were ever appealed.

8% first-submission denial rate; 60% of leaders saw denials rise in 2024

Single-specialty medical group practices averaged an 8% first-submission denial rate in 2023, and 60% of medical group leaders reported their denial rates increased further in early 2024.

$2.8 billion annual savings from electronic claim status adoption

The healthcare industry could save $2.8 billion annually by fully adopting electronic claim status transactions, reducing the manual phone calls and portal lookups used to track denied and pending claims.

40 PA requests per physician per week; 13 hours of staff time

Physicians and their staff complete an average of 40 prior authorization requests per physician per week, consuming an average of 13 hours of physician and staff time, and 40% of physicians employ staff who work exclusively on prior authorizations.

95% report care delays; 79% report treatment abandonment

95% of physicians say prior authorization delays patients' access to necessary care, and 79% report that patients abandon a recommended course of treatment because of prior authorization challenges.

26% of physicians reported a serious patient adverse event

26% of physicians reported that a prior authorization delay or denial led to a serious adverse event for a patient in their care, including hospitalization, life-threatening events, or permanent disability.

35% fully electronic; 65% partially or entirely manual

Only 35% of medical prior authorization transactions are conducted fully electronically; the remaining 65% are partially or entirely manual, relying on phone, fax, or email.

Manual PA: $10.97 vs $5.79 electronic; $494M annual savings potential

A manual prior authorization transaction costs providers an average of $10.97, versus $5.79 when fully electronic, and full automation of prior authorization industry-wide could save $494 million per year.

60% of practices involve 3+ staff per PA; 35% spend 35+ minutes each

60% of medical practices said at least three employees are typically involved in completing a single prior authorization request, and 35% reported spending upward of 35 minutes on average per request.

52.8 million PA determinations in 2024; 80.7% of appealed denials overturned

Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024, up from 49.8 million in 2023, and 80.7% of appealed denials were partially or fully overturned.

6.81% single-specialty no-show rate in 2023

The single-specialty aggregate no-show rate at US medical groups rose to 6.81% in 2023, up from 5% in 2021 to 2022 and approaching the pre-pandemic benchmark of 7% recorded in 2019.

73% of PT patients missed at least one appointment per care episode

In a large national study of outpatient physical therapy, 73% of patients missed at least one appointment during a given care episode, with no-show rates ranging from 15% to 31% across clinics, states, and providers.

73% of leaders report under 25% of patients self-schedule

73% of medical group leaders report that 25% or fewer of their patients use digital tools to self-schedule appointments, and only 11% of practices have a majority of patients self-scheduling.

26-day average wait for a new patient appointment

The average wait time to schedule a new patient physician appointment across 15 major US cities is 26 days, up 8% since 2017 and up 24% since 2004.

No-shows named top patient access priority by 27% of leaders for 2026

In 2026, no-shows ranked as the top patient access challenge for practice leaders (27%), ahead of online scheduling (24%), phone access (22%), and wait times (21%).

40% front-office turnover; 33% billing/business-operations turnover (2022)

Front office support staff in medical practices hit a 40% turnover rate in 2022, while business operations support staff, including billing, reached 33% turnover, both well above cross-industry norms.

Support staff per physician fell from 5.08 to 3.0 (2019 to 2022)

Medical practices lost support staff per physician from 5.08 FTE in 2019 to 3.0 FTE in 2022 for physician-owned practices, with primary care physician-owned practices losing more than 3 FTE support roles per physician over the same period.

58% of practices cited staffing as their top challenge

58% of medical practices ranked staffing as their single greatest challenge heading into 2023, outpacing concerns about expenses (20%) and revenue (17%).

33% turnover for admin support at behavioral health facilities (2023)

Administrative support personnel at behavioral health facilities had a 33% turnover rate in 2023, the highest of any job classification surveyed across 462 facilities.

15% SLP growth (2024 to 2034); about 13,300 annual openings

Employment of speech-language pathologists is projected to grow 15% from 2024 to 2034, much faster than average, with about 13,300 openings projected annually, largely from workers leaving the profession.

14% PT growth (2023 to 2033); about 13,600 annual openings

Employment of physical therapists is projected to grow 14% from 2023 to 2033, much faster than average, generating about 13,600 openings per year, many driven by the need to replace workers who leave the field.

80% of health systems exploring or using GenAI for RCM; 38% jump

80% of health systems are exploring, piloting, or implementing generative AI tools for revenue cycle management in 2025, a 38% jump in less than two years.

63% adoption but only 15% positive ROI

63% of healthcare organizations use AI in the revenue cycle, but only 15% of those that have integrated AI-powered automation have achieved a positive ROI.

51% cite IT infrastructure as the top barrier; 44% budget; 43% integration

51% of healthcare organizations cite IT infrastructure limitations as the single biggest obstacle to adopting AI and automation in the revenue cycle, with lack of budget (44%) and integration challenges (43%) close behind.

25% of providers use AI in admin workflows vs 50%+ of health plans

Only 25% of provider organizations use AI tools in administrative workflows, compared to more than 50% of health plans.

30% to 60% reduction in cost to collect

AI enablement of the healthcare revenue cycle could cut cost to collect by 30 to 60 percent and free the workforce to focus on high-value expertise and patient experience.

$200 billion to $360 billion in annual net savings; 5% to 10% of spending

Broader adoption of AI in healthcare could generate net savings of $200 billion to $360 billion annually, representing 5% to 10% of total US healthcare spending.

$53 billion industry; 50,883 clinics; $871K average revenue; 6.4% projected growth

The US physical therapy clinics industry generates approximately $53 billion in annual revenue across roughly 50,883 clinics, with average clinic annual receipts of $871,000 and a projected 6.4% annual growth rate through 2030.

75% of PT practices hired staff solely to manage payer requirements

Three out of four physical therapy practices have hired administrative staff solely to manage payer requirements, diverting resources directly from patient care.

85% say prior auth harms patient outcomes; 57% dropped a payer network

85% of physical therapists report that prior authorization requirements negatively affect their patients' clinical outcomes, and 57% of practices have discontinued participation with at least one payer network due to administrative burden.

9.5% vacancy rate vs 4.8% national average; about 13% of PT/PTA roles unfilled

Outpatient physical therapy clinics carried a 9.5% national vacancy rate in 2024, nearly double the US all-industry average of 4.8%, with approximately 13% of all PT and PTA positions left unfilled.

About 30% cumulative cut; 5 consecutive years of fee cuts (2021 to 2025)

Medicare payment rates for physical therapy have fallen by nearly 30% over the past two decades, with 2025 marking the fifth consecutive year of cuts under the Medicare Physician Fee Schedule.

266.9% increase in ABA therapy visits (2019 to 2024)

ABA therapy visits increased 266.9% from 2019 to 2024, with Medicaid-covered services growing 298% and commercially covered services growing 249% over the same period.

135% growth in provider supply vs 266.9% growth in visit volume

Despite a 266.9% surge in ABA visit volume from 2019 to 2024, the supply of behavior analyst providers grew only 135% nationally, meaning demand is significantly outpacing the clinical workforce.

1 in 36 children (2.8%) identified with autism spectrum disorder

The CDC reported in 2023 that 1 in 36 eight-year-old children (2.8%) had been identified with autism spectrum disorder, up from 1 in 44 (2.3%) in 2018. Findings are from 11 surveillance communities and are not nationally representative.

$14 per eligibility check; 24 minutes (3x longer than generalists)

Behavioral health providers spend an average of $14 and 24 minutes each time they verify a patient's insurance coverage by phone, fax, or email, three times longer than the time generalists require.

25 minutes per manual PA vs 14 for generalists; $8 savings per automated PA

Behavioral health providers spend an average of 25 minutes obtaining a prior authorization manually, versus 14 minutes for generalists, and automating that process could save about $8 per authorization.

8 of 9 MA organizations require PA for behavioral health; CMS audited none

A 2025 GAO report found that 8 of 9 selected Medicare Advantage organizations required prior authorization for behavioral health services, and that CMS did not target behavioral health in its oversight audits, leaving a gap in access monitoring.

$4.6M (2020) to about $85.6M (2024) in Nebraska Medicaid ABA spending

Nebraska Medicaid's ABA therapy spending grew from $4.6 million in 2020 to approximately $85.6 million in 2024, a 1,757% increase in four years, triggering state audits and rate cuts of up to 79%.