We are a nation divided. Our two major political parties agree on essentially nothing. Republicans cannot agree even amongst themselves how to proceed on health care reform. It is demoralizing that even though U.S. health care has sunken to last among developed nations, our elected leaders are unable to envision or agree upon any effective solutions. We could all use a win. When it comes to health care reform, administrative simplification could provide that win.
American health care is an administrative mess. Administrative costs are roughly double in the U.S. compared to other nations. Recent studies show that for every hour of patient care, doctors spend two or three hours on administrative tasks. Getting paid for even the most basic health care services is unbelievably complicated and time-consuming. Doctors and nurses struggle to keep up with ever-expanding documentation requirements for clinical notes and orders for tests and treatments.
Overly complicated HIPAA privacy and security regulations add to the burden (but detract from good health care). And the government-mandated electronic health record (EHR) Meaningful Use program has forced a generation of physicians to focus more on data entry than patient care. Patients struggle with a sea of confusing rules and red tape as well. It is something that drastically needs to be fixed, which is something that, lo and behold, we can all agree upon. That’s right! There is something we can all agree upon.
And administrative simplification is right in line with core Republican values. Republicans abhor Big Government and over-regulation. Reducing administrative overkill is a perfect opportunity for Republican leaders, who could dramatically improve the American health care system, lessen the heavy hand of government, and decrease unnecessary health care spending. Health care professionals and patients of every political stripe would be in favor of such changes. Even politicians from across the aisle might be supportive. I know, it almost sounds too good to be true!
There is a laundry list of items that could be included in legislation to reduce health care administrative burdens. The “Health Care Administrative Simplification Act of 2017” could include all or just a few of the following items. I’m sure my blog readers will have other suggestions, as well (and that is appreciated).
1. Dramatically simplify the government’s evaluation and management (E&M) level-of-visit coding algorithm and sets of codes. Since 1995, physicians have been forced to use an incredibly complicated calculation to determine how much they can charge for a simple office visit. The calculation is, in many ways, more complicated than the actual office visits. It is so complicated that many practices need professional “coders” just to help prepare and process claims for their services. The system generates an incredible amount of waste, distraction, and unnecessary expenses. It could and should be dramatically simplified.
Eliminate billing for most medical office visits and simple services and procedures in favor of point-of-service payments: getting paid today for basic medical services is a cumbersome, error-prone, multi-step process, where it takes an incredible amount of work to collect what amounts to a relatively small sum (an average primary care office visit nets about $75 from Medicare). A bill for a Medicare patient’s office visit can go six different places between deductibles, multiple co-pays, primary insurance, secondary insurances, and patient portions of the bill. It is wasteful on an incredible scale. The entire process could and should be eliminated, and replaced by point-of-service payment cards (just like a credit card) that would transfer the money automatically. Along with #1 above, this would go an incredible way towards reducing the unnecessary administrative burdens and costs of today’s health care system.
2. Streamline HIPAA regulations. Current HIPAA regulations are so difficult to understand and comply with that they defeat their own purpose. Less would inevitably be more.
3. Eliminate the EHR meaningful use program (or its new inception, the Advancing Care Information program) entirely until EHRs are more user-friendly and can compile and analyze data without the added work necessary to do such things today.
4. Suspend the new government MACRA value-based payment system until there is more comprehensive health care reform and there are far more functional EHRs available and in the hands of most (if not all) physicians. The government is about to begin paying (or penalizing) physicians based on quality and cost data, which makes no sense in a system where many patients are unable to afford (or the health care system itself actually impedes) the best quality care. Much of what transpires in a physician’s office is beyond their control, including patient behaviors and socioeconomic factors. It makes little sense to penalize doctors under such circumstances.
5. Eliminate or streamline prior authorization requirements for most basic testing or treatments. Both government and private insurances are relying more and more on time-consuming pre-authorizations for patients to receive medical care. It is another burdensome layer of administration that makes it harder for patients to get the care they need and clinicians to give them that care. Such processes should be reserved for truly extraordinary care.
6. Unify all professional licensing, certifications, and credentialing under one location and set of processes and require all health care entities to use that site. Doctors and other health care professionals are required to comply with and maintain licensing, certifications, and credentials for multiple insurance companies, multiple state licensing divisions, Medicare, and each state’s Medicaid providers. Each organization uses their own set of standards and requirements. It is expensive, time-consuming and is a significant impediment to doing the business of health care. Most of this should just be eliminated, and all health care entities should go to one umbrella site for all such things.
7. Reduce documentation requirements for clinical notes and orders.
I am quite sure that this represents just a fraction of the many ways we could improve American health care through administrative simplification. But enacting even a fraction of these changes would represent a major victory for a health care system, a political system, and a country that is in bad need of a win.
Matthew Hahn is a family physician who blogs at his self-titled site, Matthew Hahn, MD. He is the author of Distracted: How Regulations Are Destroying the Practice of Medicine and Preventing True Health-Care Reform.
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