Doc = Drop Out Club? 5 baffling things in healthcare

Doc = Drop Out Club? 5 baffling things in healthcare

Say we met 10 years ago during the early stages of our business. And you asked me this: would healthcare delivery be more complicated in the future?

I would’ve shaken my head animatedly and said “no, it would be simpler!”.

I would’ve shown you technology trends. And told you that healthcare transactions will indeed become more automated, much simpler. Repeatable administrative tasks would be tech-enabled, algorithm driven.

As a company, we started life in billing claims for doctors. Back then I was quite sure billing would be way less complicated in the future. Insurances and hospitals would make sure that happens.

In fact, I would often urge our people to learn and upgrade their skills faster because their jobs would disappear soon.

I was wrong. Actually, very wrong.

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

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

We never used to spend so much time obtaining prior authorizations (PA) before doctors perform procedures. Now we do. On an average, doctors today spend 16.4 hours per week or 853 hours every year on prior authorizations. Average wait time of response is 1-2 days.

I recently visited a hospital that houses some of the world’s best doctors. They can’t handle the PA burden. Their gastroenterology division spends 30+ days on average. Imagine what that means for a patient who urgently needs a procedure.

While PAs represent a bulk of the burden, there are many costs that add up. What’s worse is doctors are left with no choice but to meet these expenses. If they don’t, they don’t get paid.

Baffling thing #2: Healthcare law would get more and more complicated

On Jan 1st, 2017, a new law to track physician performance went into first gear. It’s called Medicare Access and CHIP Reauthorization Act of 2015 (or simply MACRA).

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. Check it out here.

MACRA measures are converted to a point-based system. Using points, doctors are compared to other doctors. A score is derived based on what they could’ve done vs what they did. That finally determines how much someone makes.

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

Baffling thing #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 it hurts their relationship with their patients. Some quit medicine altogether unable to deal with the technology.

My company recently completed the third stage of our Meaningful Use certification (now bucketed under the MACRA law) for our own EHR. It took our team us 6 weeks plus. The first stage took us a week. The second possibly 2-3 weeks. It’s reflective of how complicated the qualifying criteria have become.

Mandates require that doctors use certified technology to document their cases. If they don’t, they’ll lose money in the future.

Baffling thing #4: Coding would be so complicated. Creating 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 say 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.

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

It’s called the “Drop Out Club” – a networking site where doctors counsel one another to leave medicine. Burnout. Lack of enthusiasm. Depression. Long work hours. Increasing burden of bureaucratic tasks.

Read: In “Drop Out Club” Doctors Counsel One Another on Quitting the Field

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

Of course, I’m excited about the future. As a business, we keep developing a service or product to address the problems that we see. We figured that’s the best way to move forward in healthcare. Be more useful by solving problems that our clients face.

But 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 healthcare be more complicated in the future?

I’d still shake my head and say “no, it’ll be simpler!” I’ll point you to today’s technology trends in artificial intelligence and machine learning. Without question, healthcare delivery will be simpler and more automated.

Of course, I’ve no idea what I’m talking about.


Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 


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