Posted on Dec 07, 2016
With lives literally at stake for many patients who have come in contact with the industry, high technology and massive investments in new care and new therapies, the stakes for getting healthcare and healthcare policy right are high. Unfortunately, healthcare has become highly politicized and populated by deep-seated corporate interests, making an already complicated industry even more convoluted.
Recently, the market has undergone some rapid and significant changes, not all for the better. Declining reimbursement rates, new federal regulations and market consolidation have left the homecare industry in disarray and left many patients in the lurch. This does not mean the industry is doomed by any stretch - merely that there are a few changes that could be made to make the industry much better. Here are some of the common sense changes we think would make a big impact in the industry:
Rational Payments and Regulatory Policy From Medicare
To date, the most disastrous changes in the healthcare system have come from Medicare. While we can all get behind the idea of saving the taxpayer and the government money and rooting out fraud and bad suppliers from the business, Medicare’s changes have come through in an ill-thought out and ham-fisted way that is harming patients. Reimbursement cuts have made some key service so expensive or unprofitable to provide that companies - ourselves included - have had to pull out of entire markets. When the rate at which Medicare reimburses a service drops by over 50% or more in one year, it is unsustainable to continue providing that service. Unfortunately, patients lose in this scenario and are left scrambling for care. The rate setting process - which emphasizes the lowest of the low bids, many of which are not even real bids, over quality of service - has been an umitigated disaster. Quality and service are being marginalized and patients are suffering because of it.
Beyond payments, Medicare policies and audits are actively inhibiting providers from delivering timely care to their patients. We fully support enforcing honesty and quality care - we have been accredited by the Joint Commission since 1999 and many of our internal policies exceed those set by Medicare and private insurance companies - but the way they are gone about is all-consuming and prevents providers from delivering care. A convoluted approval system often delays the release of key equipment and therapies to our patients, and Medicare’s audits can take weeks at a a time and consume hundreds of staff hours that could be otherwise spent delivering care to patients. Changing to a more rational policy and audit system could save hundreds of man-hours and get care out to patients faster and more accurately.
More Transparency From Private Insurers
Ever read your healthcare policy from cover to cover? Probably not - it’s 50-100 pages long! Health insurers cover or have rules for literally anything you can think of, from injuring yourself by dropping an anvil on your foot to covering complex cancer treatments. That thoroughness comes at a cost, however - a convoluted, confusing fee schedule that more often than not leaves patients in the dark about what they actually owe for a therapy. Yes, you are probably covered for CPAP therapy, but it might be partial coverage, covered by a co-pay, or a portion of your deductible. Who knows, you might not be covered at all! If you’re wondering how private insurers calculate the cost of your care, join the club! Fee setting is one of the most opaque and least understood portions of healthcare, even for experts.
More transparency and an easier to understand fee schedule on the side of private insurers would go a long way towards helping patients understand their therapy and reducing the number of headaches all around. Nothing disappoints us more than hearing from an angry patient and having to pass them on to the insurance company, or having that angry patient file a complaint against us when we had nothing to do with it. For example, prior authorizations are the most common cause of delayed therapy - more transparency and faster communication with the insurance company could resolve a great many of our issues!
As we’ve noted before, we collect a ton of data about you and your therapy. Your doctor does the same, as does your insurance company and any specialists you might visit. On its face, this is great! The more we know about you, the better we can deliver your therapy and the more targeted it can be. However, a lot of the data we collect is relatively useless, or has already been collected elsewhere! Your doctor, your insurance company and Cape Medical all have to collect the same basic information, but often times we have to re-collect it and re-enter it into our system because our system can’t talk to the insurance company, the insurance company's system can’t talk to the doctor’s system and so on and so forth. The amount of resources spent on collecting information that has already been collected elsewhere is staggering. Additionally, a lot of the useful data we do collect - such as your sleep data and patient notes - can’t always be shared with other people who have the right to access it because the systems don’t connect to each other, limiting the effectiveness of your care across the healthcare spectrum.
If each system played better in the other’s sandbox, we could devote much more time to focusing on optimizing patient care and delivering an even higher standard of care to our patients. Without interoperability, we are forced to spend our limited time and resources collecting redundant information. Interoperability would allow us to cut out non-value added activities and re-focus more resources on delivering top notch care to our patients.
In conclusion, several tweaks to the existing system could result in major gains for patients and healthcare providers. When the system is working smoothly, everybody benefits. When undue pressure is put on one part of the system, the whole structure can become unstable, leading to issues up and down the chain. By freeing providers to be more nimble in providing care to patients and allowing all parties involved in the healthcare system to easily communicate information, patients will benefit and the whole healthcare system will improve.