3 ms·

Indeed, imagine a system where some providers are cash-only. They wouldn't even care about that ICD-10 stuff, let alone pay even the cost of entry for the propr

by mmt 8y ago

Indeed, imagine a system where some providers are cash-only. They wouldn't even care about that ICD-10 stuff, let alone pay even the cost of entry for the proprietary coding system. Of course, I realize, that were an insured patient to use such a provider, that would shift the insurance claims burden onto the patient (much as is often the case PPO out-of-network claims today), but this could be a point of competition for would-be insurers under your proposed system.

ethbro 8y ago
If a patient is cash-only, how would their electronic records be stored, if not ICD-* compatible?
- mmt 8y ago
  Using any technology that predates ICD-*, including paper. Current regulations may preclude using anything but a compatible EMR, but this implementatino detail is hardly fundamental to the practice of medicine.
  - ethbro 8y ago
    Ironically, when I asked an old timer about the IDC field format, I was told they were that way "because that's how they were on the previous paper forms." Point being, using proprietary data formats works up until you need to share data (e.g. labs, consults). And then the forms are the API. So either you're writting a translator or you aren't communicating with the other system. But this is prolly a bit of a tangent. Standardized forms and coding are actually a huge benefit to efficiency. The biggest loss in productivity (I saw) is the back-and-forth nature of the system. Provider submits claim. Insurance rejects it. Phone call is made. Claim is updated. Insurance rejects it for a different reason. Claim is updated. Claim goes through. Note: rejections are usually for technical / procedural reasons, not necessarily not wanting to pay the claim. And that process is different for each insurer. If you really wanted to eliminate hours spent in billing, enriching the "negotiation" phase somehow would be best. But also difficult because you're essentially coding the legal contract between insurer and provider, then attempting to apply it to an actual situation. And have to play nice with the existing systems on both sides.
    - mmt 8y ago
      > when I asked an old timer about the IDC field format, I was told they were that way "because that's how they were on the previous paper forms." That's not actually surprising, since the current insurance/billing situation easily predates the prevalence of EMRs (the recency of which those of us in the computer industry may have forgotten). > But this is prolly a bit of a tangent. Standardized forms and coding are actually a huge benefit to efficiency. I don't doubt standardization is a boon to efficiency by some measure. However, it doesn't necessarily translate into better medicine (which was my tangent). Less tangentially, it may not translate to cost savings, especially for a cash-only business, where it may be merely a premature optimization. Least tangentially, there's little reason to believe that continuing with existing standards, skewed toward insurance/billing (which I admit more describes CPT than ICD), is more efficient for a cash-only provider than an alternative.

by mmt 8y ago

ethbro 8y ago

If a patient is cash-only, how would their electronic records be stored, if not ICD-* compatible?

mmt 8y ago
Using any technology that predates ICD-*, including paper. Current regulations may preclude using anything but a compatible EMR, but this implementatino detail is hardly fundamental to the practice of medicine.
- ethbro 8y ago
  Ironically, when I asked an old timer about the IDC field format, I was told they were that way "because that's how they were on the previous paper forms." Point being, using proprietary data formats works up until you need to share data (e.g. labs, consults). And then the forms are the API. So either you're writting a translator or you aren't communicating with the other system. But this is prolly a bit of a tangent. Standardized forms and coding are actually a huge benefit to efficiency. The biggest loss in productivity (I saw) is the back-and-forth nature of the system. Provider submits claim. Insurance rejects it. Phone call is made. Claim is updated. Insurance rejects it for a different reason. Claim is updated. Claim goes through. Note: rejections are usually for technical / procedural reasons, not necessarily not wanting to pay the claim. And that process is different for each insurer. If you really wanted to eliminate hours spent in billing, enriching the "negotiation" phase somehow would be best. But also difficult because you're essentially coding the legal contract between insurer and provider, then attempting to apply it to an actual situation. And have to play nice with the existing systems on both sides.
  - mmt 8y ago
    > when I asked an old timer about the IDC field format, I was told they were that way "because that's how they were on the previous paper forms." That's not actually surprising, since the current insurance/billing situation easily predates the prevalence of EMRs (the recency of which those of us in the computer industry may have forgotten). > But this is prolly a bit of a tangent. Standardized forms and coding are actually a huge benefit to efficiency. I don't doubt standardization is a boon to efficiency by some measure. However, it doesn't necessarily translate into better medicine (which was my tangent). Less tangentially, it may not translate to cost savings, especially for a cash-only business, where it may be merely a premature optimization. Least tangentially, there's little reason to believe that continuing with existing standards, skewed toward insurance/billing (which I admit more describes CPT than ICD), is more efficient for a cash-only provider than an alternative.