How in the world did we end up with the colossal mess of bureaucratic overhead in health care? Let’s go back in time to see what got us here.
During the first trimester of this century, health care was largely free of interests, which have now firmly attached themselves to the health care delivery system, resulting in exponentially escalating costs while in recent years reducing net income to the traditional health professionals. What began as an intense and knowledge-based relationship between patient and doctor evolved into convoluted maze of corporate and bureaucratic confusion.
The fragmentation of health care delivery systems, ad hoc grouping of recipients and providers of service, third party differential standards for billing, and benefits allocation have prevented the controls and incentives which otherwise emerge in a free market economy. Effects are across-the-board cost increases, continually changing record-keeping requirements, (often reflecting administrative and regulatory perceived demands rather than provider/patient needs) bureaucratic overhead, and expanding medical malpractice litigation. These costs, over 2 trillion dollars annually, result in steady marginalizing benefits to the consumer in an increasingly competitive health care industry.
How did we arrive at such a wasteful, costly and counter-productive health care social environment?
This century has experienced a complete cycle in the style and mode of providing health care. A vignette from the turn of the century would portray health care as a family doctor in a one-horse shay making his rounds to a patient’s home, not only intimately knowing each family member on a personal level, but also every detail of the medical history because he had diagnosed and treated all of their diseases, injuries and illnesses from birth.
Then came the nation’s industrialization and urbanization. Those unable to afford to pay a doctor to come to their homes or who had chronic incapacitating illness or who suffered with communicable diseases demanding quarantine received health care through government or charity funded “hospitals” whose social burden was the “care of strangers.” Until World War I, hospitals were institutional “poor houses” subsidized as public charities. Most of the patients were indigent, often stigmatized for having to be treated at such institutions. The hospital was recognized as almost a “place to die.”
As technology made inroads into what had theretofore been regarded as an art, the need to more specifically categorize diseases, illnesses, injuries and appropriate treatments led to medical specialization which, over time, co-opted hospitals by distributing “staff privileges” according to standards of care defined by the specialties staffing those “departments”. The next half-century marked health care as a technologically based service. Following the line of least resistance it also became increasingly hospital-oriented to the emerging specialties converging in increasingly complex, scientifically sophisticated and increasingly costly care process.
To counter the costs, medical specialists began to develop alternative facilities such as “ambulatory” clinics, in which hospital overhead not associated with the specialty clinic would be theoretically eliminated. Such clinics were removed from the overhead that urbanization, economics, and other specialty related technology had imposed on hospitals and institutionally based care.
One result was the emergence of health care as an economic enterprise, which in turn engendered competitive styles, and alternative health care modalities theoretically free of constraints and “shared cost” inefficiencies of complex and expensive hospitals. Health care enterprises evolved, including specialized clinics, urgent care and emergency centers, outpatient surgical suites, birthing centers, laboratories, etc., operating profitably and efficiently outside professional and economic constraints of the now “traditional hospital.” Along with their advent, came a whole new set of billing rules (and more governmental interaction).
Sound familiar? The practical result has been a proliferation of health care skills and medical specialties, replacing the turn-of-the-century doctor, secure in judgment based upon intimate familiarity of the individual’s history and personal health care needs.
When problems of billing and payment allocation are compounded with the obvious need to keep a finger on the pulse of medical advancements, diagnostic and treatment procedure codes and nomenclature evolution, providing for and managing the care insured groups, enrollees, and dependents, and individual members of self-insured groups, massive data management and real time processing are imperative, however daunting.
In 1990, the Government Accounting Office reported that a logical solution to the misinformation and lack of information eroding the underpinnings of the system could be overcome by integrated financial and medical records from data made available to providers as part of the diagnostic and treatment protocols. To serve such a need the medical records should include financial, personal and family historical, demographic, biographic, and diagnostic and treatment histories, and incorporate these with billing and claims processing routines but keep the entire record confidential (yeah, right).
The catch! The report concluded that the required infrastructural changes needed throughout the entire system were so vast and the programming effort so daunting, implementation would cost roughly $680,000,000 (which has likely tripled today).
Purchasing risk of one’s own disease through indemnity coverage is perhaps the only illustration in an enterprise-based economy, which is at once the central conduit and controlling unit for the provision and delivery of service. The absurdity of this is compounded by the fact that access to and compensation for this service is or ought to be universal and in constant demand and is the means of compensation for nearly 70% of the nation’s health services. Health care now represents a sizable percentage of the GNP in the United States!
Risk purchasing establishes a contractual relationship between employers and payers, who themselves calculate health risks according to actuarial formulae. But how much does that risk actually cost? How much should it cost? The answer is elusive because added to the cost of risk are commissions, overhead, administration, claims adjusting, etc., with payers and providers forced or encouraged to provide staff and services whose defined role is to outguess his or her counterpart on the other side.
Enter Obamacare, a system guaranteed to virtually bankrupt Americans. The costs are prohibitive and the benefits dismal. The costs for the infrastructure for information management are out of control and burdened by the addition of the new ICD-10 diagnosis codes mandated for use this year. Providers will struggle to make time to see patients since so many other tasks will require his/her time.
More than ever, the problems and the specialization are so intense, that even the office personnel required to support the whole process on the provider side are impacted. For over 40 years, Med-Certification has been training people to do these jobs at www.med-certification.com, where billing, coding, and various other medical office specialists learn the functions necessary for a provider to survive.