考研阅读精选：纸质账单 用处不多 浪费不小
『每年有数十亿美元被医生、医院以及保险公司浪费在了纸质账单上。』Billions Wasted on Billing
纸质账单 用处不多 浪费不小
Nov. 12th 2011 | from The New York Times
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LAST year I had to have a minor biopsy. Every time I went in for anappointment, I had to fill out a form requiring my name, address,insurance information, emergency contact person, vaccination history,previous surgical history and current medical problems, medications andallergies. I must have done it four times in just three days. Then,after my procedure, I received bills — and, even more annoying,statements of charges that said they weren’t bills — almost daily, fromthe hospital, the surgeon, the primary care doctor, the insurancecompany.
Imagine that repeated millions of times daily andyou have one of the biggest money wasters in our health care system.Administration accounts for roughly 14 percent of what the United Statesspends on health care, or about $360 billion per year. About half ofall administrative costs — $163 billion in 2009 — are borne by Medicare,Medicaid and insurance companies. The other half pays for the legionsemployed by doctors and hospitals to fill out billing forms, keeprecords, apply for credentials and perform the myriad otheradministrative functions associated with health care.
Therange of expert opinions on how much of this could be saved goes as highas $180 billion, or half of current expenditures. But a moreconservative and reasonable estimate comes from David Cutler, aneconomist at Harvard, who calculates that for the whole system — forinsurers as well as doctors and hospitals — electronic billing andcredentialing could save $32 billion a year. And United Health comes to asimilar estimate, with 20 percent of savings going to the government,50 percent to physicians and hospitals and 30 percent to insurers. Forhealth care cuts to matter, they have to be above 1 percent of totalcosts, or $26 billion a year, and this conservative estimate certainlymeets that threshold.
How do we get to these savings? First,electronic health records would eliminate the need to fill out the sameforms over and over. An electronic credentialing system shared by allhospitals, insurance companies, Medicare, Medicaid, state licensingboards and other government agencies, like the Drug EnforcementAdministration, could reduce much of the paperwork doctors areresponsible for that patients never see. Requiring all parties to useelectronic health records and an online system for physiciancredentialing would reduce frustration and save billions.
Butthe real savings is in billing. There are at least six steps in theprocess: 1) determining a patient’s eligibility for services; 2)obtaining prior authorization for specialist visits, tests andtreatments; 3) submitting claims by doctors and hospitals to insurers;4) verifying whether a claim was received and where in the process itis; 5) adjudicating denials of claims; and 6) receiving payment.
Substantial costs arise from the fact that doctors, hospitals and othercare providers must bill multiple insurance companies. Instead ofhaving a unified electronic billing system in which a patient couldsimply swipe an A.T.M.-like card for automatic verification ofeligibility, claims processing and payment, we have a complicated systemwith lots of expensive manual data entry that produces costly mistakes.
The Affordable Care Act requires the Department of Health and HumanServices to develop operating standards for electronic eligibilitydetermination and payment — steps one and six — in the next few years,but we need to go further. We need the standard operating rules toencompass authorizing tests and treatments, submitting claims, verifyingwhere in the process a claim is and the real-time adjudication ofdenials. And we must accelerate the process, covering all steps by 2015.Finally, the government needs to require that all parties — doctors,hospitals, insurers, government agencies — use the electronic systems.
This platform of electronic eligibility, claims and payment would — inaddition to saving billions of dollars in paperwork — facilitateanti-fraud measures like those used by credit card companies. It wouldease the administrative burden on doctors, letting them do the work thatreally matters — treating patients. Finally, it could improve carethrough built-in guidelines; if a doctor tried to schedule a stentimplantation for a patient with stable heart disease, the system couldtell him to try medication first; if he tried to order an M.R.I for apatient with normal back pain, it could tell him to prescribe physicaltherapy first.
There is nothing more infuriating thanneedless paperwork that wastes tens of billions of dollars. Banks, FedEx and scores of other businesses have eliminated paper bills andpayments, and allow people to easily track transactions and packagesonline. It’s not brain surgery. Health insurance billing can also bebrought into the Internet era. (762 words)
文章地址：
http://opinionator.blogs.nytimes.com/2011/11/12/billions-wasted-on-billing/
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