Health Insurance Overprocessing Muda

If I had a category for “What are they thinking?” I would probably tag this post with it.

Patient has an eye exam that is covered by her health insurance.

The doctor’s office bills the insurance company.

The insurance company disallows $29.32 in charges because they are above a contractual amount.

The insurance company sends a check for $29.32 to the patient to cover the disallowed charges when she gets the bill from the doctor for the balance.

Do I even need to frame a “Why?” question here?

I think it stands on its own.

Just scratching my head.

Yes, I saw the statements and the check with my own eyes.

Looking at the wrong stuff: America’s Best Hospitals: The 2009-10 Honor Roll

This news piece, America’s Best Hospitals: The 2009-10 Honor Roll, originally got my attention because I hoped someone might be actually be paying attention to the things that make a real difference in our national debate about health care.

Unfortunately, it looks like more of the same.

This survey looks at things like technical capability Рwhat kinds of specialty procedures these hospitals can perform, and their general reputation  and then ranks them accordingly.

But where are we asking about the basics?

Which hospitals kill or injure the fewest of their patients? What is the rate of post-operative or other opportunistic infection? How about medication errors? These are the things that all hospitals should be “getting right” and yet the evidence is overwhelming that most don’t. Further, nobody seems to be paying attention to it except tort lawyers.

Now take a look at this post on Steven Spear’s blog, and especially the Paul O’Neal commentary that he links to.

Tell me what makes a “good” hospital?

Paying the Bills vs. Dealing with the Costs

House Dems want to tax the rich for health care – Yahoo! News

The health care debate in the USA is increasingly focused on how to pay (meaning who will pay) to operate a dysfunctional system with costs out of control.

I fully acknowledge that in government circles, this is about the only thing they can address.

But the real question is not “How do we pay?” but “Why does it cost so much?”

The care delivery system itself is error prone, dangerous for the patients (and psychologically dangerous for the providers). The net effect is much of the effort of the dedicated, but overworked, staff is siphoned off to deal with problems and chaos that shouldn’t be there in the first place. But there is no system in place, at least not in any operation I have ever see (including some claiming to be “lean”) that systematically detects, responds, corrects, and solves those thousands of little issues that occur every day. People seem too focused on the “big stuff” that creates lots of press.

The financial system is worse. The processing of payments and claims is inefficient (which is a kind word), error prone, chaotic, unresponsive to issues and problems, and treats the patients as though deciphering the “THIS IS NOT A BILL” statements is the only thing they have to do.

Honestly, I don’t have any ideas here. I just see that we are in a political quagmire debating how to pay for a system that shouldn’t be costing half of what it does… and it isn’t about controlling over payments or sharpening pencils on the billing.

What if one major HMO actually “got it” and became the Toyota of health care. Any takers?