Like many Americans, I have had to work through reams of paperwork on behalf of a recently hospitalized family member.
My father’s heart bypass surgery produced more than 20 bills, including from the family physician who initially discovered the problem, the ambulance that took him to the hospital, the cardiac surgeon, the internist, the anesthesiologist, the radiologist, the pathologist, the rehabilitation therapist and others.
Obtaining the expected payment from Medicare Parts A & B, as well as from a supplemental policy, took more than nine months. One might laugh if it weren’t so time-consuming and such a hassle.
The Clinton administration’s task force on health care reform, led by Hillary Rodham Clinton, no doubt will address the health care paperwork issue. But administrative simplification, the code words used to describe what is needed to tame the paperwork monster, may become a postscript to other weighty issues. We should not allow that to happen.
We can, and should, move quickly to define a process to fix this problem. We should use existing technologies to establish national uniform electronic processes for various health-care functions that currently require paperwork. And we should ensure that all health-care sectors are required to participate.
Sounds easy, doesn’t it? Unfortunately, there is no invisible hand that guides the health-care administrative process.
Payers (insurance companies, Medicare, health maintenance organizations, and others-some 1,500 organizations in all) determine the processes to confirm benefits and eligibility, the data needed for payment and the method to remit payments. Although there is a universal billing form for use by hospitals and another for most physician office visits, the requirements for completion of these forms and the data necessary to accompany them significantly vary among payers.
Hospitals, physicians and other health-care providers further complicate the process by developing individual charges for the smallest of items. Also, current reimbursement systems encourage the separate billing of various services, which produces a plethora of bills. Because no one is in charge, the problem only gets worse.
To fix the problem, national standards must be established. And to ensure that everyone-including Medicare and other government programs-participates, Congress must act.
Congress should mandate that all players in the health-care arena follow the same rules, use the same standards to transmit information electronically and develop consistent definitions and data requirements. Obviously, the actual development of these rules, standards and definitions would be done by a panel or commission of experts from the various groups affected. Congress should establish such a commission and provide it with the authority to serve as the hand that guides the process.
It may take a full year of debate to come to consensus on how to deal with the major issues of health-care access and cost management and several more years to make the transition to the new system. Instead of waiting and letting the paperwork monster continue to grow, we can do something now to solve this problem and save time, money and aggravation.
