Monday, August 22, 2011

Healthcare is Different Part II

I recently posted a blog entry,  Healthcare is Different, examining the ways that healthcare differs from  other businesses.

Numerous folks sent me email agreeing and disagreeing with my points.

Here's a compilation of some additional ways that my readers suggested healthcare is different.

*Domain Expertise - the vocabulary, science, and physical skills necessary to practice medicine are very complex compared to most other professions.   For example to become a neurosurgeon requires kindergarten-high school, 4 years of college, 4 years of medical school, 7 years of residency, and generally a 2 year fellowship.   That's 30 years of education.

*No second chance -  In retail, if a good is defective it can be exchanged.  In service businesses, there is the concept of a redo, a repair, or renovation.  The concept of "returned goods" does not existing healthcare.

*Trainees.   There's probably no industry that is so inundated with "trainees" as health care; especially in an academic medical center.  They add a level of inefficiency during the learning process that is required to produce the next generation of health care workers.   In other industries, trainees come in small streams as you bring in co-ops, interns etc.    They don't come by the hundreds in July of each year.

*Highly regulated and compartmentalized workforce.   Healthcare has dozens of professionals whose practice is limited to certain privileges.   This inhibits mobility and cross-coverage that could improve the efficiency of the workforce.   If demand gets light in Cardiology, you can't easily move the clinicians to the Gastrointestinal suite.

*Reimbursement and payment process.   There is a well defined commercial code for how payment occurs in most industries.   In health care, each payer creates their own rules.   In aggregate, these rules represent thousands of pages of policies and procedures that a health care provider must follow to be paid.   For example, Medicare's claims processing manual is over 4,000 pages long and this doesn't include national and local coverage determinations, advisories, and other manuals devoted to specific types of Medicare sponsored activities.   Add to this the claims processing rules for Medicaid and private health plans and you have an overwhelming regulatory and compliance challenge.  A cynical person might suggest that payers and government agencies purposely create rules that no provider can possibly follow, then seek compliance penalties for the arcane rules they created.    Providers are in a losing battle to keep up with rules that are in a constant state of flux.

These are all great observations.  

My personal goal is to build software and workflow processes that make the complex seem easy, reducing the burden on providers so that they can focus on what's really important, the patient.   That's why the work for a healthcare CIO will never be done.

1 comment:

GreenLeaves said...

My sense is that people enjoy stating that things are too complicated to simplify.
In my experience there an infinit number of improvements that can and will incrementally improve healthcare. This is why I derive so much pleasure from implementing clinical systems and striving to make the workflow support the user rather than visaversa.
There is no single magic bullet to do it all, so keep designing and building!