Business Trends

Fixing America’s Broken Health-Care System

In Uncategorized on July 13, 2009 at 7:02 pm

With a growing number of patients unable to pay their medical bills due to the economic downturn, the fever for healthcare reform is running high in Washington, D.C., and politicians are lining up on both sides in offering solutions.  It’s clear that healthcare providers are facing a perfect storm that combines growing costs, declining revenues and industry reform. What’s also clear is that providers will need to become more innovative than ever in finding ways to boost economic efficiencies without lowering standards of care.

That aside, “Changes in medical technology will underpin growth in utilization of hospital care, contributing to rising overall U.S. health care spending”, said George van Horn, senior analyst at market research firm IBISWorld.

In a survey conducted by MedAssist, when asked which categories afford the greatest savings opportunities for hospitals, 29% of respondents pointed to improved technology (e.g., electronic health records, computerized physician order entry), while 26% mentioned preventative care and chronic disease management (e.g., asthma, diabetes). Survey participants also cited streamlining administrative costs and reimbursement contingent upon quality outcomes (both at 21%) as viable areas for cutting costs.

Outsourcing financial/revenue cycle services and implementing new IT programs – over cutting fixed cost – is considered as being one of the best strategies to reduce hospitals’ administrative costs.

Policy makers are already overlooking  many of the key opportunities in addressing what is really broken about the system. Some key considerations  in implementing an efficient health-care system include the following:

1. Restore Competition in the Marketplace

The four largest carriers in the country have 99% of providers in the network and in most states, the #1 carrier has 60-70% market share. In any other industry, this would raise antitrust issues, but for healthcare, no one seems concerned.  Solution?  Break up the BUCA monopoly (Blue Cross Blue Shield, United Healthcare, CIGNA and Aetna) and restore competition to the marketplace.

2. Enable the American Consumer to Become an Astute Buyer of Quality Healthcare

The key to cost control is to bring transparency to pricing. For example, a California patient who needs a chest X-ray is charged anywhere from $120 to $1,519; in fact within a few blocks in Sacramento the price climbs from $451 to $790 from one hospital to the next. The solution – every provider must disclose the net prices that they charge and consumers need to know how to find high-quality care.

3. Eliminate Hidden Revenue Streams

Do away with fragmentation in the healthcare delivery system, and instead, all Pharmacy Benefit Managers must fully disclose all sources of revenue or profit, block doctors from owning the diagnostic machines they refer their patients to, ban trips, money and other incentives from drug companies to doctors and force hospitals to disclose profitability and markup to implant devices.

4. Our Health – NOT Healthcare – Crisis

The nation is hysterical over 18,000 cases of Swine Flu, yet we have 100 million obese people in this country. The current administration should create an aggressive public campaign to promote a healthy lifestyle, restore funding for physical education in schools, as well as institute the use of prevention-based healthcare.

5. Facilitate Administrative Efficiency

Real savings can be realized by ensuring that the government define a standard for claims submissions between providers and payors, drive a set of rules for dealing with pended claims that makes sense, among others.

6. Protect the Risk Pool

The only way to make universal coverage work is to make sure it’s universal. The first step – mandate that all employers offer insurance or force them to contribute to a government fund. In addition, we need to limit coverage to basic minimums set nationally, and to ensure that everyone can afford coverage; we should require carriers to pool risk above a certain amount per claimant.


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