Monday, November 23, 2009

Reforming health care, one inefficiency at a time

We all know that the health care system in the US needs reform one way or another. There are some big overhauls required, for sure, but there is a general level of complete inefficiency from an administration, billing and payments perspective that many find shocking. These inefficiencies just cut into the profits of the providers, some would say. True enough, and they are then reflected in what providers charge insurers, which eventually comes back round to hit the businesses and individuals that must pay for that insurance. Nothing comes for free, and when there are unnecessary costs reducing the quality of service and the cash directed at actual patient care, these things matter.

So, whether you care about the fixing health care, or just making a business run better, one area for providers to look at is how they manage billing and collections. Even in fairly routine hospital encounters, a patient may receive services, drugs and other medical items that may be billed through multiple departments. How well have the Account Receivable departments for each department bothered to work together? How often are bills presented to patients from each department individually, often for an invoiced amount less than the cost of actually generating and collecting the amount due. The same is true for small providers such as a clinic or doctor's office. Here the issues are often focused on handling paper, tracking bills and payments and handling patient inquiries.

If it is the IT systems that are in place that force this inefficiency, that is a tough nut to crack. If it is really due to the business processes for managing the entry of billable items, the consolidation of invoices across departments, or the workflow for collections, those are things that should be simpler to address.

The great thing about business processes, especially those that span departments or help small organizations, is that they can skirt the edge of the business systems you already have in place. A new or improved business process can help join the dots - providing a way to put a meaningful line of communication between the current silos of activity. Initially, there is no need to consider a rip-and-replace of systems, or complex integration. Doing something is typically better than doing nothing - and when doing something saves a significant amount of money in printing invoices, mailing bills, chasing payers or patients and hiring temporary workers to handle high workloads, you can start to see the opportunities for doing something bigger in the future.

US health care needs to achieve some quick wins on its path to a full reform. A lesson in reducing waste, putting in some business processes where there are none, and streamlining others, could be a quick win for many.

A post from the Improving It blog

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