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What Fun Doesn’t Look Like
A few days ago, The Wrap published a flattering article online about the peculiar joys offered throughout the pandemic by the sole remaining Blockbuster, which seems to enjoy timeless contentment in Bend, OR. That it took the uniquely disagreeable context of Covid-19 to remind the public of the “satisfaction” of going to the movie store should not be understated. Shining at the top of the list of virtues is that it gives people an opportunity to “walk around and [get] an idea of what they want to watch,” as opposed to beloved streaming platforms like Netflix and Amazon Prime that ask little more than brandishing the TV remote and enjoying a curated viewing experience made possible through modern and optimized technologies that record taste and suggest new ones.
Am I the only one who finds himself in a state of acute psychological duress even considering that ancient before-time when Netflix didn’t exist and the merchant of cinematic bliss was either anemic cable TV showings or the local video store, with its disorganized aisles and t-shirts and flavorless candy for sale? Contemplate all the frustrations alleviated by the advent of streaming platforms: no longer must you fight for the last copy of Men in Black II, no longer must you wallow in the turmoil of one more stop on the arduous commute home from the office, no longer must you stand in the unsmiling queue before the cashier fumbles through the directory trying to discern just which David Hampton you are, no longer must you endure all this only to discover five minutes into the screening that the film you methodically and nervously appointed tonight’s recreation is a complete flop, rendering the whole escapade humorlessly futile! Let Bend, OR enjoy its claim to the last Blockbuster, thank you very much.
The exceptional thing about evolution in technologies—and cultural embraces of them—is that they solve an inconvenience that the consumer had been unaware of but avidly adopted as soon as it was popularized. With the pitiful exception of the fetish for that one unkillable Blockbuster (and a fetish, of course, lays claim to a fixation not shared by the majority), Netflix necessarily erased the mind-numbing inefficiencies of the video store experience. Otherwise we wouldn’t be reading articles about the final Blockbuster!
Healthcare is not exempt from this type of consumer scrutiny. The majority of patients will no more tolerate providers that have not embraced modernization, whose practices do not incorporate patient engagement programs, alternatives to in-office visits, ways to prepopulate information and longitudinal care, than they would side with Family Video over Netflix or Amazon Prime. Optimization in healthcare, like any other industry, utilizes analytics to improve care, trim costs and gain efficiencies, all things the consumer is growing more attached to and would be pained to do without. Employing these technologies transforms practices and gives patients that modern healthcare experience they’ve come to expect.
Practices that resist modernizing, optimizing and transforming, anchor patients—that massive stratum of partial judges who dictate the future without having any foreknowledge of what it will look like—in a bleak sea of video stores that sooner or later they’ll flee, for a land where innovation has helped “realize” some unconscious wish.
Interoperability: A Love Battle
It is in some ways flattering that in the great anonymous corners of the world there are known faction warring for our allegiance as consumers. We feel important, valued, both good feelings. This is perhaps one of the only upsides to a role otherwise troubled by a deluge of solicitations, misleading campaigns, trash beauty products, bad food, toothpaste, fad diets, false appeals to the heart.
Being vied for becomes a bit more muddled, however, in healthcare debates, an industry in which the consumer is even less surefooted due to the processes required in really getting a firm handle on that foreign organism that is the human body (I feel confident, for instance, making decisions about the right brand of cereal, yet I’d feel less good about applying that independence to heart medicine) and all the red tape that interferes with accessibility, not to mention the dire consequences of getting it wrong. But if you pay attention, bigwigs in the healthcare industry make appeals to us as consumers quite strongly too.
In February 2020, HHS announced that it’s adopting interoperability rules put out last year by the CMS and ONC aimed at addressing access, exchange and use of electronic information, and preventing healthcare organizations from using information blocking tactics. HHS director Alex Azar said the rules are “essential to building a healthcare system that pays for value rather than procedures, especially through empowering patients as consumers.” HHS, it appeared, made the decision with us at the fore of its mind.
Over the past few years much of the industry has begun shifting away from redundant fee-for-service models toward value-based ones. This has helped lower costs by pushing treatment courses on the merit of their effectiveness, not profitability. So when HHS announced it would be implementing measures for easier data sharing that push this evolution forward it was mostly seen as positive.
Yet shortly after the publication matters were complicated when healthcare software giant Epic, out of Madison, WI specializing in EMR and EHR software storage, sent a letter signed by an unavoidably lengthy list of hospitals citing concerns over patient privacy. Founded in 1970, Epic is one of the largest storage houses of EHRs so you would not be alone in seeing their defense as mere protection of a de facto stronghold using the guise of patient privacy to conceal this special interest. A more sympathetic view might see them as experts attuned to the complexities of software storage who worry that opening data sharing up for purchase and exploration by third-party IT groups might put at risk sensitive medical information.
The notable thing, though, is how both HHS and Epic cling to the noble position of being defenders of patient and consumer interest. But mark how differently, how interchangeably, the two employ the term consumer and patient, how malleable the term is, with HHS using the language of choice, empower, and Epic, defense and protection, and both reaching antithetical opinions over what is best for us. To be a consumer in this context is to be a very important abstraction, the most important empty chair in the room.
Regardless of who is closer to the truth both parties should take seriously their claims of devotion to the consumer by investing and not hamstringing innovations that might help solve some of the irrefutable headaches that plague this industry. As patients and doctors, as consumers endowed with the power of indifference and ire, it is high time for us to stop being seen as cynical pawns in this tumultuous debate over what is best for the consumer of healthcare while being largely excluded from the conversation. We should be courted as the formidable consumer base we are and looked at as discriminating entities more than willing to turn away from inferior practices, irrespective of which of our supposed protectors is claiming to hold us dearest.
Surprise Medical Billing (Balance Billing) Potential Federal Legislation
Update: Surprise Medical Billing (Balance Billing) Potential Federal Legislation
Many emergency medicine groups are currently out-of-network with major private insurers, and therefore bill patients the difference between their charges and what the insurance company paid (referred to as “balance billing”).
This scenario may cause friction with patients and hospital administrators, especially where the hospital itself is in-network with the payer. However, many emergency medicine groups believe the in-network rates offered by some private insurers are inadequate and leave them no choice but to remain non-par with those payers.
Such bills are often included under the term “surprise medical bills” because patients were treated at an in-network facility, but the provider group itself was out-of-network and balance billed the patient. Some states have already addressed surprise medical bills and pressure has mounted on Congress to take action at the federal level.
This month a flurry of activity on Capitol Hill has produced legislative drafts, hearings, and announcements focused on surprise medical billing. The Senate, House, and Administration have all announced plans to address the situation, including a number of possible approaches. All agree that the patient should be taken out of the process and be responsible for only their in-network deductibles and co-insurance.
Final legislation is likely to contain recommendations from legislative and other stakeholders, which propose various solutions, such as:
- Set Rates: pay out-of-network providers a median in-network rate
- Network Matching: require all hospital-based providers be contracted with the same payers as the hospital
- Bundled Billing: prevent hospital-based providers from submitting claims or billing patients (the facility would provide a single claim, including professional fees; physicians would be reimbursed by the facility)
- Consent: Require patient notification and consent to balance bill for out-of-network services
- Arbitration: create arbitration processes for providers and payers disputing the amount of out-of-network reimbursement
- Databases: create state-based databases to collect claims and payment data for all payers
- Price Transparency: healthcare providers to furnish expected costs for services to patients in advance of treatment
- Network Adequacy: requirements that insurers provide adequate networks
Innovative is closely monitoring the situation and will be part of a group visiting with congressional and administration officials in Washington next month regarding healthcare reform in general, and surprise medical billing in particular.
Innovative executives are actively involved in national organizations that help inform and guide policymakers on healthcare issues, including: Healthcare Business Management Association (HBMA), American College of Emergency Physicians (ACEP), Emergency Department Practice Management Association (EDPMA), American College of Osteopathic Emergency Physicians (ACOEP), Workgroup for Electronic Data Interchange (WEDI), and others.