October 21, 2013

What’s the Deal?

By

I have come to the conclusion – no, I have reaffirmed my existing conclusion – that healthcare in these United States of America does battle from no less than five camps.

The Four Pillars of Healthcare

First there are the providers, both institutional and professional (euphemisms for “bricks and mortar” and “people,” respectively). They provide the care, and therefore they appropriately may be considered the foundation of the entire system. Without healthcare, there is no “healthcare system.”

Their primary mission:

 

  • To provide the best care possible.
  • Their secondary mission: To make money

Then we have the insurance companies, including government insurers, non-government insurers, and those who choose to self-insure. They provide the mechanisms by which most of us gain access to the provider component of the healthcare system. 

  • Their primary mission: To share some risk with beneficiaries and anyone else who will join them.
  • Their secondary mission: To make money.

Next, we come to the employers, who provide insurance for their employees. This is an expected benefit – at least among larger employers – that often is considered a right. But employers are one of the two most influential segments of society that actually produce nothing within the healthcare system.

  • Their primary mission: To assist their employees in managing the risks of health maintenance as a means of retaining those employees.
  • Their secondary mission: To make money.

This brings us to the fourth pillar of American healthcare: the government. Between the states and Washington, D.C., government has seemingly unlimited power to effect laws, rules, and regulations that often produce sweeping changes to the core healthcare system.

  • Their primary mission: To stay in power. After all, it’s not their future they put at risk.
  • Their secondary mission: To “make” money (that is, to print more, when necessary) to spend while pretending to save money to benefit all of us.

And, in the Center of It All…

Now we come to the heart of the system, its raison d’etre: The providers’ patients, the insurers’ beneficiaries, the employers’ employees, the governments’ citizens … yes, you and me. As simple as it sounds – and is – we are the heart of the system. If we never needed healthcare, there would be no healthcare system.

  • Our primary mission: To avoid the healthcare system at all costs.
  • Our secondary mission: To be at odds with everyone else in the healthcare system, as it is our money that everyone else thinks should be their money.

Know and Believe

Providers want us to know and believe that the new building, the high-tech equipment, the office complex, the degrees on the wall, even the luxury cars in the parking lot, all are proof of their dedication to ensuring that we have the best care money can buy, should we ever need it.

Insurers want us to know and believe that their only interest is in keeping our premiums as low as possible while keeping those wicked providers under control.

Our employers want us to know and believe that keeping us healthy is good for their bottom line (which actually is true), and they really want us to enjoy the best possible value in our healthcare benefits. Oh … and if you will please quit actually using those benefits, we can keep the premiums down.

And the government wants us to know and believe that everything the bureaucrats and elected officials do is for our own good. (If you doubt me, just ask them.) OK, yes, there is that little Patient Protection and Affordable Care Act (PPACA) thing that did some truly great things, like eliminating lifetime maxima and “pre-existing conditions,” but it also did some things that – for most of us – are not so good.

All About Us

All of which brings us full circle to us: The patients/beneficiaries/employees/citizens who can become the victims of all the self-serving activities of the four pillars:

  1. Providers’ charges so high they become incomprehensible? Accept it.
  2. Stratospheric insurance premiums? Accept it.
  3. Higher healthcare costs for our employers? Accept it.
  4. More government intrusion into areas previously considered “personal and confidential?” Accept it.

And yes, believe it or not, this all comes back to ICD-10.

I know that appears to be quite a stretch, but it’s not. You see, ICD-10 is a good thing; even I agree. But it’s costly, it’s difficult to implement, and it’s incrementally non-beneficial to each individual among us. (My life will not be measurably better or worse because of it.) But it’s good for “society” or “the system,” and that – in concert with money – appears to drive healthcare policy decisions in this country. 

 Until next time…

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, Texas. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.