Last week I read a story that mentioned a study that came to this conclusion: Only 14% Of Medical Errors Reported By Hospitals. It’s an alarming story, one that undoubtedly is true, but it’s the kind of story that leads to hysteria instead of understanding.

Overall, the question comes down to what constitutes an error. For instance, leaving a sponge in a patient after a surgery is definitely an error. Not changing the top sheet between patients in the emergency room is nasty, but that’s not considered an error, although OSHA would be all over it if they knew about it.

The standard for reporting errors comes down to what’s known as “medical harm”. That’s kind of a questionable standard because one could say that the act of a medical professional not washing their hands, thus setting up the possibility of viruses and germs spreading, is medical harm, but that’s not a reportable offense. When I had an issue with some of the care my grandmother “wasn’t” getting while she was an inpatient at the hospital last May I knew that some of what I saw as deficient wasn’t reportable officially either, though I did take it to a hospital representative as a complaint.

There are always standards for what’s reportable and what’s not. Even the story linked to leans toward the fact that hospitals aren’t reporting everything because they don’t have to. This kind of goes across the board by the way. There are things not reported as it pertains to almost every department in a hospital that end up being errors, yet not officially reportable errors. Heck, there are lots of billing errors every day, yet very few would be considered serious enough to report to anyone.

Strangely enough, we probably should be happy for some of this. Imagine being a hospital employee worrying that you’re going to make mistakes every time you do a procedure. That’s the type of thing that breeds mistakes, when people are scared to make them. Incompetence is one thing, slight errors that don’t lead directly to patient harm are tolerable. We might not like them but we have to be thankful that patients are fine.
 

Copyright protected by Digiprove © 2012 Mitch  Mitchell

Health care in America is in trouble. It’s in trouble for many reasons, but I tend to believe it’s all related to money. Although people outside the industry tend to believe that hospitals are making money hand over fist, the reality is that the majority of hospitals in this country are either losing money or are barely breaking even.

Because of all the changes that have occurred and changes that will be occurring, most hospitals only think about one thing; cutting stuff. It’s a pattern that both state and federal governments do when they start talking about reimbursements, and it’s the same thing many regular insurance companies do as well.

The thing is that hospitals really can only cut so much. They’ll start laying off nurses when there’s actually a nursing shortage and that creates a major backlog of work for those remaining, which is bad for patient care. They’ll lay off people in the billing office when those are the people who bring the money in that pays all the bills and payroll. They’ll lay off maintenance people who keep the equipment running because they can’t afford to buy new, and they’ll lay off cleaning people and take chances that they’ll fail OSHA regulations because there aren’t enough people to keep things sanitary.

At a certain point hospitals need to start thinking more about their revenue. The old models of believing that only budgeting based on traditional inpatient stays is failing; it’s been failing for a long time now. I actually understand why they do it; collection agencies follow the same principles of working with the “biggest bang for your buck”.

But things are much different. I can’t tell you how many former inpatient services there are that now are outpatient services. No one seemed prepared for that at the time, and years later I see hospitals doing those services, yet not concentrating on making sure they’re capturing all of the procedures properly, let alone making sure those procedures are coded properly.

What needs to happen is the same thing that governments need to figure out. When you’ve cut as much as you possibly can it means you have to find a way to generate new revenue. It means you have to find something that’s a need in your community and exploit it. You don’t need to add the same thing the hospital down the street has added; you need to have something different, something you can hang your hat on, something that will bring in sustainable new revenue to offset all the costs.

What do I propose? Truthfully I’m not sure. Each community will have something that’s lacking, that they can create and generate new revenue from, so it’s not a universal thing. But it can’t be something that ends up costing more to do than the community will support. We don’t need every hospital buying things such as MRI because there’s not enough use of them to warrant it. We could probably use more physical therapy sites and outpatient surgery centers, possibly even getting more into elective surgeries. The money is there, and so are the clients.

And of course make sure your CDMs are up to date, and that your staff understands the charge capture process. Without that you’re just lost, no matter how many initiatives are put into place. Oh yeah, did you know I provide CDM services?

Copyright protected by Digiprove © 2011 Mitch  Mitchell

No, we’re not talking fishing here, which means we’re not talking about fishing poles. We’re talking health care, and something most people have no real clue about is this item called a “charge master“. I actually gave a one paragraph explanation about charge masters 3 years ago, but it’s not really sufficient. Since I wrote my post about inpatient hospital charges I felt like I needed to give a better explanation, being a charge master consultant, so here it is.

A charge master is a list of things that a hospital or physician can or will charge you for. I say it that way because they “can” charge you for almost anything, though they shouldn’t. On a charge master, or CDM for short, you will have procedures, supplies, pharmaceuticals and different room charges. Overwhelmingly they will be priced; some hospitals or physicians will use their CDM as a tracking device, which I don’t like but since those items aren’t priced I feel if they’re labeled properly then it’s all good.

Why will medical entities have something like this? There are many reasons:

1. It helps with capturing charges. People don’t have to constantly research the code books and pricing list to see what they did and figure out how to charge for it.
2. There are literally thousands of items that can “legitimately” be charged for. There are nearly 3,000 procedure codes, more than 10,000 different pharmaceuticals, and unlimited numbers of supply items.
3. Each has a chance to clean up or modify what they do easier. With a list of charges and other such things they can have someone like me come in to help them figure out how to do it easier and better.
4. It helps with billing. This is actually the biggie. With charges come charge codes, procedure codes, revenue codes, sometimes modifiers, general ledger codes, and descriptions. In total it’s a bit much to have to go over on a daily basis.

Depending on the types of services a hospital provides, the CDM can be anywhere from 5,000 line items up to more than 25,000 line items; ouch! If a hospital never eliminates old procedures and supplies, it will definitely be huge. And yet I love working on these things; maybe I’m the sick one.

Now, if you’re not in health care this is probably all you want to know about the technical part of it. You now want to know how all of this impacts you; why should you care.

The reason consumers need to know about these things is because it gives you knowledge that if you call the hospital to ask how much something costs, there’s a document, even if it’s online, that can give the right person that amount so they can clue you in.

Now, finding the right person might be harder than you think, but at least you know the information is there. Truth be told, most hospitals don’t have someone who’s specifically over the charge master. This means that you can call to ask how much something is and you might get passed around from person to person. Many departments that provide services don’t keep this on hand, though they should. Billing departments don’t normally keep it on hand because the price of items has nothing to do with the billing process; yes, that’s true. Many billing people don’t have access to a charge master.

But you do. At least in some states. You can request an entire copy of the charge master, or you can at least see all the prices for whatever it is you need to have done. Surgery is kind of a red herring in that no hospital can definitely tell you how long a physician will need in performing surgery on you, and you don’t want physicians rushing your surgery just to save you money so if you’re told to estimate an hour and it takes two, just make sure all your parts are working when you get home and be happy with it. You never know what’s going on during a surgery.

In some states hospitals are required to send charge masters to them for some type of review, like Pennsylvania, which means you could get your information from the state. They’re not happy about that though. Many hospitals will put their CDMs online, and some even hire a person to respond to all calls asking about pricing.

But the reality is that most people don’t call to ask for any of this information. Even with all the outcry’s about being overcharged many people don’t check on price before they get procedures done. Having insurance mutes a lot of those worries, and knowing you have to have something done anyway scares a lot of people from wanting to know.

Anyway, I hope I’ve given enough information to the layman about charge masters. If you have any questions for me I’m happy to answer them; that is, unless you’re looking for CDM advice. Then I have to charge you; I am a consultant after all.
 

Copyright protected by Digiprove © 2011 Mitch  Mitchell

I talk a lot about leadership on this blog but I’m also a health care finance consultant that concentrates on charge master issues. What this means is that I help hospitals look at their charges to see if they’re coded properly, being priced fairly, and are being captured properly so that they know they’re capturing the most revenue in the most accurate and fair way possible.

What this also means is that I sometimes tell them that what they’re charging for is either ridiculous, illegal, or just plain wrong. The reasons for things like this are:

     * not understanding the rules
     * charging for things that aren’t payable
     * charging for things that aren’t supported by diagnosis
     * charging for things that aren’t supported by the medical record
     * charging for things that are stupid as sin

Some hospitals are doing it intentionally; others just don’t know. The main thing is that, for the most part, it’s not really impacting you, the patient. If you have insurance, you have nothing to worry about because your bill is being paid based on diagnosis rather than the actual charges. However, if you’re a self pay patient… well, in some states hospitals have been forced to set you up so you get some kind of relief, while in others you’re still officially responsible for the whole thing.

I would never call out any hospital by name because they might be a potential client. However, I can guarantee that the hospital whose bill I’m highlighting now will never call me as a consultant, as it’s the hospital my grandmother was taken to back in May when she fell at home, the one where she had her operation that she never recovered from, the one I went to and talked with representatives about care failings I noticed, and the one where I used to work in the system with before I became an independent.

I had to request an itemized bill for my grandmother recently, and of course I looked at all her charges. Luckily she had Medicare, so she wasn’t going to be responsible for the entire thing. But what I saw has irritated me, and I’ve seen it at a few other hospitals as well. So, if you’re reading this as a hospital be a little scared because I’m about to reveal some issues, and if you’re reading this as a potential patient who might be self pay look at this as something to be ready to potentially complain about.

1. Daily supply charge. You should be insulted by this one because most of the time as an inpatient you’re not using any daily supplies. Some hospitals will tell you that they use a charge like this to offset expenses; some tell you that they charge this instead of all the other stuff they might charge you for. It’s a lie.

The problem is that many supplies aren’t covered by insurance. Some hospitals rightly won’t put those charges on the bill, but instead of a daily supply charge, which won’t be paid by anyone except self pay people, they should build the cost into the daily room rate or only charge when they have to use reimbursable supplies. No one should be charged for all things that a hospital might consider as a supply. See the next point.

2. Stupid supplies you didn’t really use. On my grandmother’s bills are charges for gloves, both powder and no-powder latex gloves. These are what’s called “non sterile” supplies, and they’re non reimbursable. In some states hospitals aren’t even allowed to bill for these items, and if they do in other states, insurance companies ignore the code they’re supposed to go under. If you get billed for things like gloves, blankets, sheets, slippers (she got billed for slippers that we know she never received because my mother took slippers to the hospital the day after her surgery), most bandages, or pretty much any other supply item that’s less than $50, you should complain.

3. Low priced and multiple pharmaceuticals might be a red flag. There are often lots of medications shown on a hospital bill on a daily basis. Often these medications are dispensed based on initial diagnosis, but if you’re in the hospital a long time they’ll either change or be cut back. In many hospitals you’ll see these charges reversed if not used. In this case not a single medication was reversed, which is a major league red flag to me. Strangely enough, there are some medications she was given that aren’t on the itemized bill; I know this because I asked questions while she was there.

Hospitals don’t get reimbursed for a lot of pharmaceuticals; if there’s no code, most insurance companies aren’t paying for it. But hospitals love building up their expenses by including a lot of these things on a bill so they can build up their cost report when dealing with Medicare later on. These won’t add up to much most of the time, but the point is that you should check on these things here and there if you’re self pay.

4. Procedures that aren’t billable. On my grandmother’s bill were 3 charges for physical therapy evaluation. Per Medicare rules, you can only bill for more than one physical therapy evaluation if the patient’s status changes during the course of physical therapy treatment. My grandmother never regain any alert status in the almost 2 weeks she was in the hospital. Therefore, she never had any real physical therapy. They may have visited 3 times while she was in the hospital, but since they couldn’t do anything with her and her status didn’t change, they violated Medicare standards.

5. The emergency room charges are somewhat incorrect. If a patient is admitted into the hospital but first came through the emergency room, any emergency room charges must be put onto the hospital bill. This did happen in my grandmother’s case. However, she went into the hospital via ambulance because she fell and had a broken hip. The hospital charged as a level 5, which is the highest initial level, then added a second critical level charge even higher than the level 5. They probably do this because she came by ambulance, but they didn’t come close to giving her the care needed to reach level 5, let alone the second charge.

How do I know? I was there. Out of the first 5 hours she was in the emergency room she was by herself, not counting my mother and I, for a little over 4 hours of that time. The other 45 minutes was when they took her up to another floor for x-rays. Does that sound like a level 5 process to anyone, let alone adding an extra critical level? If she’d ended up being an outpatient and been sent home this is a claim that would have gone into review because it wouldn’t have matched the diagnosis; it wouldn’t have come close. Because it’s an inpatient it’s paid for under what’s known as the DRG (diagnosis related groups), which means the individual charges won’t be scrutinized. But if you were a self pay, you’d have paid an extra $3,000 that wasn’t valid.

If this was a self pay bill, or if I didn’t known the entire claim was paid except for the deductible, which is standard, I might make a stink about this. The last two things I mentioned could be considered fraudulent by Medicare if they chose to go that far; at the very least they’d take the payment back and not allow the hospital to bill the patient for anything extra. Other insurances might not like it if they decided to explore, but most of them would just let it go as well. Still, this hospital isn’t alone in doing this type of thing, so they’re not necessarily the evil empire here.

But they’re in the wrong, and it’s deplorable and sad. And they probably don’t care. I hope your hospital cares more about how they’re charging their patients.
 

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By the time you see this post I’ll be on my way out of town to see my mother, grandmother, and my grandmother’s brother. My grandmother is in a nursing home, something I think I’ve talked about before.

You know, I’ve been in health care more than 28 years now, and though this isn’t the first time I’ve ever questioned the kind of health care that’s really how people are treated, it’s the closest I’ve been to it for a long period of time. And I’m finding out that it’s not just patients who get the short end of things; families go through some major stress as well.

Although I’d been thinking about this for awhile, it really crystallized for me yesterday when I was having a conversation with one of the nurses at the nursing home. She was telling me that my grandmother hadn’t eaten all weekend and that she was very weak. She then said that in her opinion she didn’t think my grandmother would last more than one or two weeks.

That’s never easy to hear and it’s not easy for most people to say to someone else. However, I could take that. I know how sick my grandmother is. I’ve been to visit and I’ve seen her and I’ve seen her barely touch anything, and she certainly hasn’t been trying to help herself.

However, what got me was a conversation I had with my mother just a few hours later. She’s been going to visit my grandmother every day around lunch time and handling the feeding unless the weather is bad. My mother doesn’t drive in bad weather, and in her area it was raining heavily both days this past weekend, including thunder showers. That and her uncle, my grandmother’s only surviving brother, was trying to get into town from Las Vegas and kept having flight delays. So today was going to be his first time seeing his sister in 7 years.

They’re at the nursing home and my grandmother is sleeping. That happens from time to time. The nurse goes into the room, has no idea who my uncle is, and proceeds to tell my mother and him that my grandmother hadn’t eaten all weekend and that she was just tired and ready to die. My uncle immediately starts crying and my mother felt like it, but decided to console my uncle instead. Then the nurse, whose motives I can’t be sure of at this point because I wasn’t there and thus don’t know how she said it, tells my mother this is something she sees over and over and that it’s time to prepare for the worst.

And her saying that with my grandmother in the room is abhorrent. I have found that she’s not always sleeping, and though she can’t communicate as well as she used to be able to, she’s always listening and knows what’s going on, and she’s proven that on more than one occasion.

You know, even when something tough needs to be uttered, there’s something to be said for good bedside manners from health care professionals. There’s also supposed to be something called HIPAA, which means that just because my grandmother is in a nursing home instead of a hospital doesn’t mean some information told about her shouldn’t be done confidentially. My uncle isn’t a stupid man; he knew his sister was sick. But here’s an 86-year old man that’s spent 2 days in airports trying to get across the country to visit his sister for possibly the last time while he’s alive and he gets side-swiped like that. Who could feel good about something like that at any time?

Of course I could complain more, and did to this nurse while talking to her, about the reality that the people who are trying to feed her never seem to check to see if she’s retaining food in her mouth, which she often does for hours at a time. I could talk about the food, which us as healthy people would never eat and how that could be contributing to her, and others, not eating.

I now have a better understanding of those relative that complain about the care their relatives AREN’T getting while they’re in the hospital or elsewhere. I’m now seeing it up close and personal. I also recognize the reasons why this happens so often, but that will be for another time. Overall, my gripe right now isn’t so much with the health care system as it is about what seems to be a true lack of compassion. That’s something that doesn’t take more money or bodies; it only takes more time to care.
 

Copyright protected by Digiprove © 2011 Mitch  Mitchell

Within the health care industry, lately there’s been more talk about quality. Most of the talk involves things such as clinical efficiency, getting people out of the hospital faster, and lowering the costs of care. Only on that last one do patients seem to agree. I’ve talked to a lot of them over the years, and I’ve come to the conclusion that there’s a great divide between patients and health care professionals, whether they be in the hospital, physicians office, or elsewhere.

You want to start with quality, talk about what people see when they walk into either a hospital or physicians office. They expect clean and we give them clean. What we don’t give them is an experience. You walk into a physicians office and you see chairs and a front desk to sign in. Processes are neat and sterile, but not comforting. Same with hospitals, but scarier, as more and more hospitals have stepped up security to the point that patients are wondering if they’re going to get a pat down before they have any services performed.

Next, let’s talk about the patient’s experience. Because I’ve lost any fear of physicians over the years, I will engage my physician in conversation and I always get it back. Most people don’t do that, and thus the physician will say his or her piece then leave, and many times patients leave confused and still scared. The same goes for having procedures done in a hospital; people tell them what to do and what they’re going to do, but almost never the reason why, and just as rare no assurances. True, you can’t go around telling people things that aren’t true, but the whole process is cold and clinical once again; it may be quality in the medical sense, but it’s not quality in a patient sense.

Let’s talk about the cost of health care and the perception of quality. Medical professionals and patients see costs differently, even if they agree on the initial concept. Hospitals and physicians want to contain costs to help the profit line. Patients want costs, aka prices, to be lower so they can afford to pay for health care. Medical professionals see new technology and pharmaceuticals as a great path towards better health care; patients see it as costing them more. Whereas the perception of quality by patients used to be “if it costs more it should work better”, these days it’s changed to “if it’s better technology it should be able to do it better for less money.”

In my opinion, if physicians and hospital executives really want to work on quality initiatives, they need to bring in a few volunteer patients or potential patients and get their opinions as well. Just like I believe if one is going to implement big changes they need to talk to the people expected to do the work, I believe if one is going to try to tackle quality then those that will be most affected by the change need to have a say in it as well.

Copyright protected by Digiprove © 2011 Mitch  Mitchell

For most people, seeing the term ICD-10 means nothing. For those in health care, though, this is a very big deal. Medical billing and coding personnel will be significantly affected. For people in the United States, it’s a fundamental change that’s going to be a mess.

ICD stands for International Classification of Diseases. Basically, this is the listing of diagnosis codes. Right now we’re on Version 9; we’ve been on Version 9 since the 1979. The rest of the world changed decades ago, but we didn’t because insurance companies, led by Medicare, decided to start paying inpatient claims based on diagnosis. Then payments on surgical procedures started being paid on the same standard.

ICD-10 is going to represent something very dramatic to the claims processing process. An ICD-9 looks like this: 250.00. An ICD-10 looks like this: 250.0019. Each of the numbers after the period stand for something, and if one of the early categories doesn’t fit but a later one does, then a “x” is supposed to go in, like this: 250.00×5.

This is a fundamental change for many reasons. One, it’s now possible that what’s now a standard diagnosis (250.00 stands for diabetes) could suddenly become a major diagnosis based on what’s related with the diabetes.

Two, you know those encounter forms you see in physician’s offices and clinics? Suddenly there’s going to be a lot more codes all over those sheets, which could be a mess.

Three, both physicians and medical records personnel are going to have to go back to learn how to do the new coding, all while keeping up with the work they’re doing now.

Four, not all insurance companies have to change, such as compensation and no fault, since each state has different rules for it and it’s not regulated in any way by the federal government.

Five, most computer systems aren’t set to accept these new types of diagnosis codes, which means there’s going to have to be a lot of money spent on updating computers while at the same time spending a lot of money to update computer systems for electronic medical records per the Health Care Reform Bill.

Six, most insurance companies probably aren’t going to be ready for this change. This is based on history, as most weren’t ready for earlier changes to procedure coding back in the early 2000′s. So, even if hospitals change, insurers, especially almost every Medicaid system in the country, will probably tell everyone to keep coding the old way until they’re ready.

Big deal? You bet. The implementation date is 10/1/2013, and though that seems like a long time away, think about this; HIPAA (Health Insurance Portability and Accountability Act) was passed in 1997 and some of its directives still aren’t in place.

What does this mean to the average citizen? One, it means getting your health care expediently as it gets nearer to the time of implementation and months afterwards might not happen as everyone tries to figure out how to do the new coding. Bills might not go out as quickly, which means payments to the hospitals will be impacted and, if you owe money on the back end, you might not know about it as soon. Some people love that, but there’s always this snowball effect when things like this are put into place that people aren’t prepared for because it’s an unknown entity.

Another thing that could happen is it could be harder for awhile to get insurance authorization for procedures because insurance companies will have to figure out how to categorize similar diagnoses in new ways. That will have an impact on who gets surgery at what time; that’s scary.

And, of course, there will probably be new fee structures on services, and trust me when I say that any time there are new fee structures, they’re almost never benefiting providers, and if these folks, hospitals, physicians and the like, are hurt by any of this… well, let’s just say health care could get leaner by default and people will be wondering who’s going to be providing their care.

Alarming? Well, it’s meant to be. The truth is that things will probably fall somewhere in the middle; some will be ready, others are going to be totally caught off guard. Of course no one should be; I wrote about it in this article on ICD-10 and CPT-5 back in 2006, and this is one of the most read articles on the site it’s listed on.

At least at this point no one can say that they don’t know about it now that I’ve written about it, unless they don’t come read this post. And I know they will.

Copyright protected by Digiprove © 2011 Mitch  Mitchell

When President Obama was running for the office of president, one of the things he kept talking about was the need for electronic medical records (EMR). When he was trying to push the health care bill, one of the things he kept talking about was electronic medical records. Obviously he wanted this to occur, and saw nothing but benefits coming from it.

There has been talk about electronic medical records for a long time now. How long? I remember sitting in a board meeting for the national organization back in 2001 and asking the board’s representative on a committee known as WEDI (Workgroup for Electronic Data Interchange) if there had been any talk about encryption standards for getting this thing done. They hadn’t talked about it because they weren’t really even ready to talk further about electronic medical records since most hospitals had just come out of a period where they’d had to update their computer systems because of the big Y2K scare. Actually, for hospitals it was a big deal because many software contracts were set to expire by that date, which either meant buying new systems or upgrading, which was just about as ugly.

In a recent editorial in HealthLeaders Magazine written by the editor, Rick Johnson, he touched upon something rather interesting that I’ve found to be somewhat true. He said that most physicians have passed on EMR because physicians didn’t believe EMRs (actually, in the editorial it’s referred to as EHR, which stands for electronic health records; same thing) provided enough value for their time and money. Even with hospitals in some areas helping out with the costs and the set up, it seems physicians and their staff aren’t believing all that often that this is a better way to go than what they already have.

Case in point, I put myself up as an example. In the last few months I’ve gone for testing for 3 different things, all of which are related to the same hospital system. The hospital has EMR; the physicians aren’t on these systems. It’s not that they can’t be, just that they’re not. Each time I had to fill in information that not only have I had to fill in previous times on paper, even though they all asked for the same information. They all have their own form, which means you’re answering the same questions, only in a different place. Not only that, but in my case the first provider of services actually set up my other two appointments, and one would have thought that they’d be sharing both billing and demographic information with each other. Frankly, I know the medications I take, but only for the first appointment did I even think about what the doses were, and those happen to be the people who doled it out so they shouldn’t have needed the information to begin with.

Actually, I had another procedure at another local hospital, and wondered why they didn’t have my information already because earlier this year I had to avail myself of their urgent care services. I was told that they’re on their way to going in that direction; I kind of scoffed at the news. It’s not that I don’t believe it should come; it’s that I find it hard to believe that it’s taken this long for the hospital to even be connected with their own urgent care center, which is right across the street; makes me think physicians are going to have a much longer wait.

There’s news that all the local hospitals have gotten together and are going to pool their money and get all the physicians in the area up on EMR. The time frame is 4 years; not quite moving with all alacrity, but at least they’re pushing forward. I actually see both the benefits and negatives of EMR, but I’m going to try to remain positive for the moment. It seems the case for EMR comes from the government, the case against comes from physicians, and I’m in the middle once again. Well, I’m really not; I may talk about it a little later.

We’re in a tough place these days as it pertains to health care. Depending on which side you’re on, it’s either the fault of the hospitals, doctors, insurance companies, states, or the federal government. I’d throw the legal system into the mix as well as banks, suppliers and pharmaceutical companies. I could add to the list, but we don’t have enough time.

Here’s the thing. There are many things impacting health care in negative ways, and it’s almost an oxymoron to say that we have the best health care in the world coming from the United States. We can do some amazing things, but it all costs a lot of money. That’s why we don’t have flying cars (to answer the question from a commercial a few years ago).

Truthfully, the biggest problem facing health care today is costs, and everyone’s got them. It costs a lot to go to the hospital. It costs a lot for insurance coverage, and it costs a lot for insurance companies to pay hospitals and physicians. It costs a lot for hospitals to pay for supplies, pharmaceuticals, utilities etc. It costs a lot for physicians to pay for malpractice insurance. It costs pharmaceutical and medical equipment suppliers a lot of money to test all these things as required by law to then try to market them to hospitals and physicians. And unpaid medical bills costs everyone across the board.

I can’t solve all the problems in health care. Last March I shared on this blog my health plan for America; no one took notice. That doesn’t stop someone like me; one day someone might see something, put it in practice, and we’ll see where things go. Course, I won’t get any credit for it, but that’s okay. Because it’s okay, I’m going to throw 3 more things out there that most people probably wouldn’t think about if they’re not in health care, but it would really help all of us out.

1. Duplication of services. In the real world, you might have a Home Depot on one street and have someone decide to build a Lowe’s across the street from it (that’s actually happened here). Both stores offer pretty much the same thing, but there’s so many people who can buy from both places that even if their profits aren’t super high, both have a chance of surviving and doing pretty well.

That doesn’t work for hospitals. If one builds a sleep center and it’s working pretty well, another hospital in the area will probably start building one as well. If there are other hospitals nearby, they’re all going to start building the same thing. However, the folks who pay most of the claims are the insurance companies, and most locales have only a few insurance carriers that pay most of the claims. What happens is the insurance companies start feeling like they’re being squeezed, and they decide they’re not putting up with it. So they start paying less, and hospitals start losing money because they can’t afford to keep these things open. Eventually quality goes down because the hospitals didn’t have the foresight to allow one hospital to become the main center for certain services.

2. Grade insurance companies based on how they process claims and denials, as well as how much money they spend paying providers as opposed to paying themselves. Some of this has started in a few states, where insurance companies have to justify the increases in premiums they want every year. I’ll own up to the fact that pharmaceuticals are expensive, and care for some diseases (like diabetes; thanks insurance companies) is overwhelming. But that’s not the majority of their patients, and it also turns out that most of the money they pay for some of these things actually doesn’t go to anyone. Insurance companies set up deals with providers of payments often like this: they’ll take the physician’s fee, capt at at a certain amount based on what they call UCR (usual, customary and reasonable fees), then pay a certain percentage based on whatever calculation they come up with, then have providers write off certain amounts and either bill patients for a co-pay or deductibles of usually 20%.

What do insurance companies do with the money? Some build big, beautiful buildings. Some pay shareholders. Some take pretty big salaries. Whatever they’re doing with the money, many times less than 60% of what they have goes to providers. Under paying our hospitals and physicians doesn’t do any of us any good in the long run. Denying claims at a rate of even 25% doesn’t do us any good either. At least Medicare pays claims, even if they then go back and take a lot of money back through RAC audits. If hospitals and physicians are messing up, then that’s on them; at least they had the money for awhile.

3. Revamp charity care & allow physicians to set up scales as well. There was a statistic that came out last year saying that 62% of the people who go into bankruptcy have at least one significant health care bill listed among their debts. That’s wrong on so many levels, though I kind of understand. Medical providers deserve to get paid for services they provide, yet how many of us could come up with more than $10,000 at a moment’s notice? If your entire family’s income is $50,000 a year or more and you have 4 kids, you’re not going to qualify for any type of charity care. Any many hospitals have things set up where they want to collect on any outstanding balances within 6 months; trust me, I’ve read these types of recommendations on how to collect better from self pay patients for at least 15 years. I don’t know if physicians aren’t allowed to even offer charity care or not, but I’ve never met any that offer it.

Last year on my finance blog, I stated that the overall housing industry would have been better served if banks had found a way to try to work with homeowners instead of just foreclosing on their homes, especially at the rate they were, and still continue, to be taken. Even if they had worked out a one year deal with homeowners to accept half of the mortgage amount they’d have ended up financially ahead as opposed to taking the house and not being able to sell it because no one else was qualified to buy it. The same type of thing needs to work for health care. We have high unemployment right now across the country, some areas harder hit than others. Hospitals and physicians need to find better ways to work with patients to get at least some kind of money in on a consistent basis, no matter what the amounts are. In my opinion, even $100 a month on a $10,000 bill is money I wouldn’t be getting any other way from some of these people. It could be set up where there’s a review every 3 to 6 months to see if circumstances have changed to determine if the patient can pay more at a certain point or if the situation is more dire and other measures have to be taken. Either way, it would be patient friendly, and if there is more than one hospital in the area, the publicity would be dramatically positive.

Of course there are more complicated things that can be done, but I think these are ideas that everyone can at least understand. Too bad I don’t believe many people will see them; we’ll find out at some point, won’t we?

I was reading HealthLeaders Magazine, where they were talking about all the different things some hospitals across the country are trying to do to make the hospital experience better for patients. Some of the things these hospitals are doing are pretty good, I must say, while others are more for the benefit of the hospital than the patient, no matter how much some hospitals try to sugar coat the processes.

At this point in my life I’ve been in health care almost 28 years, and I’ve seen a lot of things. I’ve talked to a lot of patients and a lot of hospital personnel, including non-managers, directors or administrative staff. I’ve also talked to a lot of physicians, both those in hospitals and those in private practice, in professional and personal situations. And I’ve done some thinking of my own about things, and believe I’ve come up with 5 things that patients really want. Here they are, with a caveat; some of these things there’s nothing that can be done about them.

1. Patients want to know what’s going on. They want to know what’s contained in their medical record. They want their physicians to tell them what’s wrong with them, no matter how small it might be. They want someone to explain to them why they’re having certain tests done, and they want to know what those tests will tell the doctor. They want to know what information of theirs is shared with other doctors or nurses. Overall, they just want to know why they have to do things they’re told they have to do, no matter what.

2. Patients hate having to continuously fill out all this paperwork. I’m actually going through something like this myself right now with different physicians groups I’m seeing that are all affiliated. Most of them are affiliated with the same hospital; they set up the appointments. Why aren’t they sharing my information so I don’t have to keep writing out the same information time and time again? Why is it that when I copy one sheet for all of them that contains the same information they have to have it on their own sheet?

Going further, why are there so many forms patients have to fill out for hospitals and physicians? Actually, this one I know; because both state and federal governments require this stuff. Medicare is the worst for patients; there are tons of forms they have to have completed at least once a year. You fill out all this paperwork for the government, and for the protection of the hospitals and the physicians, and so hospitals and physicians can get paid.

3. Patients want extraordinary customer service. Unlike going to Macy’s, no one willingly walks into a hospital or physician’s office and asks for care; no, not even hypochondriacs. No matter what level of care you’re getting or from whom, it’s somewhat stressful. I say that as I went to a lab to have blood drawn last week, and had the phlebotomist probe one of my arms for about 5 minutes before determining she couldn’t find the vein, and had to go to the other arm. Suffice it to say that though I inject myself twice a day, I still flinch when having blood drawn; at least this time around she was nice, but that’s not always the case.

If a patient is an inpatient, they want to see a nurse on a more regular basis than twice in 8 hours. They don’t care that there are other patients, they care that they’re stuck in a room and no one is stopping in to check on them. They want to see a physician more than once a day. They want to have at least a couple of choices in their meals. And, of course, you remember point number one up there, right?

4. Patients want a better understanding of hospital charges. Of course I just wrote about hospital charges. I’ve written twice over the years about what’s known as price transparency and what it was, then about how, when it’s practiced, turns out patients don’t really care. In a way, it’s kind of like not caring about all the intricacies concerning their insurance; they just want to know if what they’re about to have done is going to be covered or not.

I tend to believe that if patients are told, whenever possible, what the costs of the services they’re about to have are, estimated of course (since things can, and often do change), and how much insurance is going to cover, and possibly talk about the relationship between what’s actually billed, allowances, and actual cash paid, along with charity care options for those that needed it, that it would make more patients understand the process, or at least feel more comfortable with it all. Of course, this will cost a lot of money to hire and train people to do it, and also takes a lot of work figuring all of these things in advance, but if a hospital or physician’s office really cared they’d do it. And I’m saying this as I received a bill today from a physician’s office with the balance I owe, and even though it’s not super high I’m still somewhat stunned by how little my insurance paid that my physician’s had to accept, and how high the percentage is that I now have to pay.

5. Patients want to know where and who to go to for any questions or concerns they have, and they want it to be easy. On this front, I know many hospitals have tried many things, some that work and some that don’t. In the magazine, there was mention of the CEO of the UCLA Health System who actually makes rounds himself, being a physician, and will drop his card off to many patients telling them they can call him at any time, 24/7, if they have any issue at all with their care.

Years ago when I was still working at one of the hospitals, we instituted a program where the person who registered a patient for an inpatient stay gave them their card and said that if there were any concerns over financial obligations that they could contact that person at any time. I wanted to extend it to any questions or complaints in general, but I couldn’t push that one through. However, at a different hospital I was at we had it set up so that clinical coordinators would try to do all follow up with patients to try to address their concerns. Our issue was that no clinical coordinators worked on the weekends, so there was a deficiency that we continued to miss. Still, we gave it a shot.

Of course, patients want more things, but I’m stopping there. I’d love to hear people’s opinions on this one, so please feel free to share.