March 8, 2019 |
According to the Commonwealth Fund, which ranks healthcare quality worldwide, the U.S. is a low performer for three dominant reasons:
Lack of coverage has received substantial attention in recent years due to the Affordable Care Act and the debate over the individual mandate. Yet it is our inefficient, disparate processes that have created a healthcare environment which, as Walter Cronkite so succinctly stated, is not healthy, caring, nor a system.
Have we lived with our processes for so long that we have become desensitized? Are we incapable of appreciating the inefficiency? We point to it, and yet we live with it…and it is from that vantage point that disruption becomes inevitable.
Take a step back and consider the following true anecdote. A student goes to the emergency room with a valid insurance card. The facility claim is processed without incident but the patient’s insurance information is never transferred for generating the corresponding professional claim. The professional bill is generated as self-pay and sent to an incomplete dorm room address.
The student eventually receives a threatening phone call from a collector who demands payment in full for the charges. The student is not asked if they have insurance. The healthcare system indicates that they are not responsible for what they classify as "claims processing issues." If this situation seems reasonable to you, take pause.
This scenario raises several questions for the industry:
Following the 2008 financial crisis, the Consumer Financial Protection Bureau was initially formed to govern consumer protection in the financial sector. In recent years, it has expanded its purview to include medical debt. The Federal Debt Collection Practices Act, passed in 1977, covers any debt which is acquired for personal, family or household purpose.
Frequently cited violations include:
As we continue the journey into a consumer-focused healthcare economy driven largely by high-deductible plans, it is imperative that we not forget who our customers are and remain client-focused. Let’s keep the “care” in health care.
Katie Christensen is a healthcare consulting manager within the Population and Payment Solutions group of 3M Health Information Systems.
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