Forbes, HFMA on Improving Patient Billing Practices

Anyone who has had medical care in the United States is already familiar with the large array of forms and bills that can be generated by even a short and simple procedure. This morning Richard Clark, president and CEO of the Healthcare Financial Management Association (HFMA) shares his experiences with medical bills and his thoughts on the subject in a column for Forbes. He begins by recounting the tale of helping his mother handle the mountain of medical paperwork left by his father's demise.

What a mess.

I developed a spreadsheet, downloaded benefit descriptions from my father's supplemental insurance company, visited Medicare's beneficiary's web site, and made a lot of phone calls. In the end, I helped my mother work though the bills (some of which were received for the first time some 12 months after my father's death). In short, I lived the nightmare of our current health care billing system.

It was this unpleasant experience that drove him to begin the project know as "Patient Friendly Billing," which provides tools and data to clinics and hospitals to streamline communication with patients. He reaches many of the same conclusions as our own Mr. Halvorson concerning both the need for unified standards and the impact of economic incentives on health care.

Almost everyone agrees the current method of paying for health care services is broken. It fosters fragmentation of care, rewards inefficiency, and doesn't distinguish between high-quality and low-quality providers. It's a mess. And there is strong evidence that the payment system drives decision making, including the level, frequency, and venue of care. The payment system creates most of this nightmare and must be fixed before any real progress can be made to improve health care in this country.

In Health Care Reform Now! Mr. Halvorson notes that there are over nine thousand billing codes for procedures and yet not a single one to denote an actual cure. He also observes that there are currently no uniform standards or measurements of performance within the industry.

Mr. Clark focuses on revamping the payment system itself as the answer to these woes. Since there seems to be an absence of guiding principles upon which to base this proposed retooling, he has been working through the HFMA to develop some. To do so they have solicited input from many involved sources including government, employers, care providers, insurance agencies, and community groups.

Some of the guiding principles discussed in his column include:

• Quality and safety.


• Simplicity and standardization.


• Fairness and efficiency.


• Community benefits and innovation.


• Transparency.

After noting "most if not all," of these principles are violated by the current system he goes on to briefly examine some possible solutions involving "out of the box" thinking.
All of these potential fixes are aimed at untangling the Gordian knot of our current billing system, with a stress laid on simplification and consolidation.

I believe it is not necessary to move away from our system of public and private insurance coverage, and public and private care providers to improve our health care system. If we design and implement payment methods that achieve a set of principles that are designed to provide high quality, safe, and efficient care, we will go a long way to improving what ills the system. It's time to wake up from the nightmare and fix the mess that is the health care billing and payment system in the U.S.

SOURCE: "The Health Care Billing Nightmare" 11/14/07
photo courtesy of unk's dumptruck, used under this Creative Commons license

System vs. System: Canada and the U.S.A.

In a new Op-Ed for the Healthcare Financial Management Association, George C. Halvorson analyses the differences between the U.S. and Canadian health care systems as well as their attendent costs.

Americans are increasingly asking why the United States is the only western industrialized country that has not managed to achieve universal healthcare coverage for all of its citizens. They also are wondering why we don't learn from our neighbors to the north and move the current Canadian universal coverage approach south. That's an interesting and important question.

[...]

Most people who know that Canada spends less money on health care believe that the cost difference is almost entirely due to the lower administrative costs that result from Canada using a “single-payer” insurance model. Is that true? No.

The truth is that Canada now spends about $2,600 per resident per year less than we spend on healthcare costs in the United States because-very simply-Canadians spend less money on the actual purchase of care.

What follows is a lucid and detailed analysis of the various contributing factors including, but not limited to:

• The Canadian Pricing Model


• Prescription Drug Coverage


• Adminstrative Costs

There is much talk of the Canadian health care system in the media as more and more Americans are drawn to the health care reform debate. This article is a wonderful source of hard numbers for anyone who is interested in the Canadian aspect of the discussion.

SOURCE: "Understanding the Trade-Offs of the Canadian Health System" 10/17/07
photo courtesy of striatic on Flickr under its Creative Commons license