5 things that confuse me about health care today

Say we met ten years ago. And you asked me: Would health care delivery be more complicated in the future?

I would’ve said, “No, it would be simpler!”

Pointing you to technology trends, I would’ve told you that health care transactions will indeed become more automated, much simpler. Repeatable administrative tasks would be tech-enabled and algorithm-driven.

My company started life in billing claims for doctors. Back then I was quite sure billing would become less complicated in the future. Insurances and health care providers would want that.

But I was wrong. Actually, very wrong.

I would’ve never guessed any of these things that baffle me about our industry today.

#1: It would cost more for doctors to make the same money

There’s more work to be done for every claim. For example, doctors and their staff spend more time on prior authorizations than ever before.

While billing represents a bulk of the burden, there are many costs that add up. Such as technology, staffing or coding. Doctors are left with no choice but to meet these expenses. If they don’t, they don’t get paid.

#2: Health care law would get more and more complicated

On January 1st, 2017, a new law called MACRA went into first gear. It tracks physician performance.

MACRA adds to the long list of regulatory mandates that practices already need to comply with. The law is applicable to roughly 55 million clinicians. It’s 2,398 pages long.

We find doctors struggling to interpret the law, leave alone moving in the direction of incorporating mandates.

#3: Technology, intended to simplify life, would end up making doctors miserable

Technology in the form of poorly designed EHRs adds to the burden of practicing medicine today. Some doctors feel that it hurts their relationship with their patients. Some quit medicine altogether unable to deal with the technology.

Mandates require that doctors use certified technology to document their cases. If they don’t, they will get paid lesser.

#4: Coding would be another avenue for insurances to delay payments

When ICD-10 arrived, clinical codes exploded to 155,000 from an earlier set of 17,000. Insurances have begun to demand greater specificity for codes that doctors submit.

For example, earlier you’d use 530.11 as ICD-9 code for Reflux esophagitis (a digestive disease). Under ICD-10, you have to get specific, and code “K21.0 – Gastro-esophageal reflux disease without esophagitis.”

Doctors aren’t used to documenting this way. So specifically. The result is more avenues for insurances to deny or delay claims.

#5: In a world of desperate medical need, many doctors would actually give up medicine

Burnout. Lack of enthusiasm. Depression. Long work hours. Increasing burden of bureaucratic tasks. There are many reasons for doctors to drop out of medicine.

To become a specialist doctor, you have to spend four years in medical school and nine more years to train under a specialty. Imagine the kind of frustration a doctor must face in order to give it all up.

Our long, messy path to the future

For businesses, it makes sense to develop products or services solving these problems.

However, I worry about the kind of long, messy path we keep traversing as an industry. A path that only gets murkier.

If we met today and you asked me the same question. Would health care delivery be more complicated in the future?

Pointing you to today’s technology trends in artificial intelligence or machine learning, I’d still say, “No, it’ll be simpler.”

Without question, health care delivery will be easier and more automated.

Maybe I’m stuck in a Groundhog Day. With an industry that repeats itself around me.

Praveen Suthrum is president and co-founder, NextServices and blogs at redo | healthcare.

Image credit: Shutterstock.com

View 10 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories