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Something that is very little known to most lay people but has profound implications on how the industry is structured are laws loosely called "Corporate Practi

Something that is very little known to most lay people but has profound implications on how the industry is structured are laws loosely called "Corporate Practice of Medicine" (CPOM). A little more than half the states have some version of them. Simply put they require that the organization legally practicing medicine must be owned and operated by people holding medical licenses only. This defacto creates a medical entity for that purpose and a sistered non-medical entity for business operations. Not speaking to the broader reasons of why those laws can potentially be good, the practical result of those laws all but requires many "middle men" in the operation of medical organizations.

paws 4y ago
TIL about CPOM, thanks! Another question I'm curious about, if you don't mind, is why there is no apparent urgency in fixing the painful billing experience for patients. (aka "why don't billing coordinators seem to coordinate with the patient front and center?") Seems like lots of people are fearful of medical billing, and not only because it's expensive. I realize providers may be out of network, carriers take time to adjust claims, etc. Still, the staggered/surprise billing seems unique to medicine and a 2nd order effect might be people avoiding preventive care to their own detriment. Say a patient goes to get some procedure done, the medical work is completed in one day. Shortly afterwards they receive bill A. OK, that's fine. But then X months later, they receive bill B with more charges from some provider that they may not even remember. I thought avoiding that was supposed to be the job of a billing coordinator. Presumably coordinators are constrained by "things" -- what are the factors that make this experience so dreadful for patients and why are they not being changed?
- duffpkg 4y ago
  I'm not sure the short answer is adequate but a few things: 1) US healthcare is absolutely huge, it's perhaps 20% of the total macro economy. Changing anything in 20% of the entire economy is going to take a long time. 2) There has been really significant changes regarding price transparency and "surprise" billing in the past 5 years, so there is momentum to improve the patient experience but see #1 3) Regarding hospitals, many hospitals might appear to be one thing but are not (some systems are fully vertically integrated). They are much more like medical malls, often as a result of CPOM. What you percieve as one thing actually involved dozens of different business entities and hence very discoordinated billing.
jsmith45 4y ago
Its not immediately clear to my why such laws should require crazy corporate structures with many middlemen when there exists similar rules that law firms can only be owned by lawyers, and they almost always just have a fairly straightforward partnership scheme for their firms.

paws 4y ago

TIL about CPOM, thanks! Another question I'm curious about, if you don't mind, is why there is no apparent urgency in fixing the painful billing experience for patients. (aka "why don't billing coordinators seem to coordinate with the patient front and center?") Seems like lots of people are fearful of medical billing, and not only because it's expensive. I realize providers may be out of network, carriers take time to adjust claims, etc. Still, the staggered/surprise billing seems unique to medicine and a 2nd order effect might be people avoiding preventive care to their own detriment. Say a patient goes to get some procedure done, the medical work is completed in one day. Shortly afterwards they receive bill A. OK, that's fine. But then X months later, they receive bill B with more charges from some provider that they may not even remember. I thought avoiding that was supposed to be the job of a billing coordinator. Presumably coordinators are constrained by "things" -- what are the factors that make this experience so dreadful for patients and why are they not being changed?

duffpkg 4y ago
I'm not sure the short answer is adequate but a few things: 1) US healthcare is absolutely huge, it's perhaps 20% of the total macro economy. Changing anything in 20% of the entire economy is going to take a long time. 2) There has been really significant changes regarding price transparency and "surprise" billing in the past 5 years, so there is momentum to improve the patient experience but see #1 3) Regarding hospitals, many hospitals might appear to be one thing but are not (some systems are fully vertically integrated). They are much more like medical malls, often as a result of CPOM. What you percieve as one thing actually involved dozens of different business entities and hence very discoordinated billing.

jsmith45 4y ago

Its not immediately clear to my why such laws should require crazy corporate structures with many middlemen when there exists similar rules that law firms can only be owned by lawyers, and they almost always just have a fairly straightforward partnership scheme for their firms.