I’m always struck by this simple concept: Dishonesty make so many things more difficult than they should be.
We see this all over healthcare. Look for example at patient privacy and security. If people were just honest and thoughtful with patient data, our privacy and security challenges would be so much simpler. Imagine how much time and heartache we’d save if people were just honest when it comes to privacy and security. Yes, I’m looking at the million of hackers that are trying to take people’s personal information. Imagine if we could focus all the money and time we spend securing applications and apply it to improving healthcare. What a difference that would make.
The same could be said for reimbursement. Our reimbursement system would look drastically different if people were just honest. Yes, I’m talking about the billions of dollars of Medicare and other insurance fraud that’s out there. What a sad expense on our current healthcare system as dishonest people try and make a quick buck. While that expense is large, the even larger cost to our healthcare system is the toll that fraud adds to the honest actors.
Look at our current model of reimbursement for healthcare. So much of our insane documentation efforts are tied to the fact that insurance companies are trying to combat fraud. They don’t and can’t trust providers billing levels and so they’ve created layer and layer of requirements that makes the healthcare documentation process miserable. If you don’t agree with me, then you aren’t someone that’s involved in healthcare reimbursement.
This expense gets passed on to the employer and patients as well. Have you ever tried to make sense of the bill or statement of benefits coming from your doctor or insurance company? It’s like trying to make sense of a new language. It doesn’t make sense since you as a patient don’t know that language. Are they screwing you over in what they’re billing you or not? You don’t know either way and good luck trying to find out the answer. The person on the other end of the phone likely isn’t sure either because it’s so complex.
I first learned this principle in the credit card world. Why on earth do we pay 3+% of every transaction we do on our credit card. The answer is simple. Credit card fraud (otherwise known as dishonesty) is rampant and why credit card transactions cost so much. Imagine a world where the doctor wasn’t giving 3% of their business to process a credit card transaction since the cost to change digital digits should be nothing.
Unfortunately, the reality is we do live in a world with a lot of dishonest people who try and game anything and everything. We have to pay attention to security and privacy with these dishonest people in mind. We have to deal with insane reimbursement requirements as these payers try and combat fraud. We have to deal with credit card fraud and pay for it in the process.
It’s unfortunate, because dishonesty almost always catches up with people. Even when we think it doesn’t, dishonesty pays its own toll on a person as they can never be comfortable. Having a clear, honest conscious is one of the most beautiful things in life.
[…] at all. In fact, it’s probably not even happening because an organization is trying to be dishonest. When you look at the complexity of an EHR implementation, it’s not surprising at all that […]
Yep, and we could leave our houses unlocked and the keys in the car.
Unfortunately, not the world we live in.
Besides, what would happen to the advertising industry??
An honest advertising industry would be nice.
Apropos, Meaningful Use
Dishonesty got us stuck with a $36,000,000,000 waste of tax payer money and huge costs and lost opportunities for healthcare.
If the vendors and the government had been honest and said that MU would decrease productivity, increase cost, and have no real effect on quality of care, we would not have been so bad off as even our government would not have mandated such a loser of a program.
OR
Even if they had honestly assessed the program midway thru and killed it, we would have been a lot better off. Instead we get dishonesty and spin.
Dishonesty has been extremely costly.
This is a great message John … thanks!
It seems to me that the system is not just built to combat fraud and waste, it can actually encourage it. Medicare, for instance, will reimburse a nearby hospital almost 10 times what it will pay a doctor’s office for the same procedure. The doctor is not sufficiently reimbursed, so sends the patient to that hospital. Now there’s no way it costs the hospital that much more, but it is allowed to bill that much higher rate and collects it from Medicare and the patient (or Medigap insurer). Of course, the hospital uses the excess to either cover other legit expenses they are not properly reimbursed for, or to expand, or for exec pay. To me it seems like legalized fraud – and it is certainly very wasteful.
[…] John Lynn takes a moment to reflect on what the world would be like with a little more honesty. His article describes the lengths that we have to go to to protect ourselves from fraudulent activity and how […]