6 ms·

As a health IT professional who did try, and will try again in 2013, this article is spot on. There are differences between France and the US - especially in t

by guylhem 14y ago

As a health IT professional who did try, and will try again in 2013, this article is spot on. There are differences between France and the US - especially in the mindset - but the payment system is very similar. In fact, the current french system (used for hospital billing since 2004, and tested for 10 years before that) was based on the US medicare DRG approach. My job is to make patients pay as much as we can legally make them pay, using any mean necessary as long as it is legal. In the past, my unit was the single most profitable in the whole hospital, by large. So I tried to sell things, and failed. I would like to insist on the "incentives" topic with a quick example: I previously developed production analysis software to find and exploit the cases where an hospital could be more efficient and thus make more money (long story short, see one of my previous posts on http://news.ycombinator.com/item?id=4826314 http://news.ycombinator.com/item?id=4826314 for more details) As I like to say, this is as good as printing money - I can say precisely what should be changed in a billing statement, why, how much it will gain, and the probability to find matching evidence in the patient file. I can calculate an expected return, so that on small cases you can use unqualified personnel, while it might be worth to have a doctor study every page of the patient file for high profile cases (since, if you don't have evidence to back your billing claim, you are legally liable - it's not unusual for a large hospital to be fined sums with 6 digits if during an audit mistakes are found) I tried to sell the software, with a commercial partner. In a year, we could only find a single client in the whole french public hospital system!! Want to know why? The improved productivity - short term financial gains - can be used to demonstrate that the civil servants in charge were not as efficient as they should have been, or that they should hold to that level of efficiency in the future. That's just like the OR example in the article - they don't want to be more efficient because basically, making more money is a liability to the top management personal career. I was quite disgusted by this twisted way of seeing things. Medical credentials did not help me. Efficiency was not welcome. Improving one's profile, even at the expense of whole hospitals profitability, was. I did not explore that much, but there seemed to be a demand for a service to selectively reduce profits, to maximize government subsidies in some units - something utterly disgusting for a libertarian. I didn't think I could do that, so I stopped. I will try again very soon, but now I will make sure to carefully study the incentives, and do something I can morally agree with.

FireBeyond 14y ago
"I would like to insist on the "incentives" topic with a quick example: I previously developed production analysis software to find and exploit the cases where an hospital could be more efficient and thus make more money (long story short, see one of my previous posts on http://news.ycombinator.com/item?id=4826314 http://news.ycombinator.com/item?id=4826314 for more details) As I like to say, this is as good as printing money - I can say precisely what should be changed in a billing statement, why, how much it will gain, and the probability to find matching evidence in the patient file." There are entire companies devoted to nothing more than this - taking a ICD9/10 diagnosis, some procedure codes and massaging the bill to get the biggest possible bill (and vice versa, as an insurer, minimizing the same).
- guylhem 14y ago
  Yes, that's the easy part - massaging the bill, testing. Providing an accurate estimation of the expected gains however require both domain knowledge and statistical analysis. Ie if your hypothesis is to add "morbid obesity", and you know how much it will gain in the bill, how likely are you to find that in the patient file, given the patient history and (hopefully) some text from the release letter? Enough to send an unqualified worker who does not understand medical speech? (you won't get paid for ideas, but for actual results - and too many false positives cost money, because humans have to do the fact checking) Do you believe it's worth putting a MD on the case? It will cost more in fixed costs, and thus reduce potential gains. Can you automate that for one patient file consisting of multiple inputs? Can you still do that for 100'000 files? How long does it take for your software to produce its result? Can it still work when it is missing some critical information you believed in your early development would never be missing - like the release letter? Textual analysis, datamining, Bayes, even sentiment mining (see http://news.ycombinator.com/item?id=4908056 http://news.ycombinator.com/item?id=4908056) etc - everything is fair game (ex: "the patient did not seem morbidly obese, but upon calculating BMI score, was") Then you have to convert the lead to a sale. I'm talking about having money in the bank. This requires more than a nod and a signature for hospitals. I know firsthand - in the end, only one hospital paid. Interest and traction are irrelevant. What matters is how much money you get in the end, and how satisfied the customer is to recommend you to others (it's a small world, especially in the health-IT field)

by guylhem 14y ago

FireBeyond 14y ago

"I would like to insist on the "incentives" topic with a quick example: I previously developed production analysis software to find and exploit the cases where an hospital could be more efficient and thus make more money (long story short, see one of my previous posts on http://news.ycombinator.com/item?id=4826314 http://news.ycombinator.com/item?id=4826314 for more details) As I like to say, this is as good as printing money - I can say precisely what should be changed in a billing statement, why, how much it will gain, and the probability to find matching evidence in the patient file." There are entire companies devoted to nothing more than this - taking a ICD9/10 diagnosis, some procedure codes and massaging the bill to get the biggest possible bill (and vice versa, as an insurer, minimizing the same).

guylhem 14y ago
Yes, that's the easy part - massaging the bill, testing. Providing an accurate estimation of the expected gains however require both domain knowledge and statistical analysis. Ie if your hypothesis is to add "morbid obesity", and you know how much it will gain in the bill, how likely are you to find that in the patient file, given the patient history and (hopefully) some text from the release letter? Enough to send an unqualified worker who does not understand medical speech? (you won't get paid for ideas, but for actual results - and too many false positives cost money, because humans have to do the fact checking) Do you believe it's worth putting a MD on the case? It will cost more in fixed costs, and thus reduce potential gains. Can you automate that for one patient file consisting of multiple inputs? Can you still do that for 100'000 files? How long does it take for your software to produce its result? Can it still work when it is missing some critical information you believed in your early development would never be missing - like the release letter? Textual analysis, datamining, Bayes, even sentiment mining (see http://news.ycombinator.com/item?id=4908056 http://news.ycombinator.com/item?id=4908056) etc - everything is fair game (ex: "the patient did not seem morbidly obese, but upon calculating BMI score, was") Then you have to convert the lead to a sale. I'm talking about having money in the bank. This requires more than a nod and a signature for hospitals. I know firsthand - in the end, only one hospital paid. Interest and traction are irrelevant. What matters is how much money you get in the end, and how satisfied the customer is to recommend you to others (it's a small world, especially in the health-IT field)