Healthcare costs and AI -it's not what you think. A nonpolitical post (please)
BaronVonZemo
64200 posts
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Since the onset of DRG's in the late 80's/early 90's, insurance companies have been slowly ratcheting down payments for specific billable services over the years.
In response, hospitals and healthcare networks and offices have been sending their biller/coders to classes to learn how to maximize billable services to counter this decrease in revenue for the same services.
The insurance industry (this now includes Medicare & state Medicaid programs as well as private insurance companies) responded with more and more charting expectations and specifications (they increased complexity of required documentation - often specifics that were irrelevant to a particular treatment, and not something that a care giver would think about as relevant from a medical perspective. They did this because they understand that in a large aggregate, it will result in more billd being able to be denied payment which will save them money.
The hospital side (by this time, large hospital systems had taken over the industry) responded by taking the clinicians away from their patient care for training sessions in the "charting game" which they referred to being a "quality provider" though it was really about being a "quality revenue maximizer" than a quality care giver. The hospital systems are greedy, and they in turn got very "creative" in finding ways to maximize their income.
The battle has gone back in forth in various ways, with one side gaining a temporary advantage and then the other over the years.
Now, Insurance companies have purchased AI products to sift through all of their care giver's charts to fins any charting discrepancy that will allow them not to pay a bill.
The care giver side has responded by spending gobs of money to purchase AI programs of their own to prepare their charts for submission. Clinicians are also being taken away from even more patient care time to address this issue with training and charting.
The care giver side is presently experiencing new deficits from the AI escalation since the insurance side implemented it first.
Medicare drives the pay scale, standard and trends on the insurance side, while big hospital systems drive it from the care giver side, so the idea that a nationalized govt healthcare solution is not a real fix. The private companies would do the same thing since it would make them money in the short term.
Neither side cares about the patients or care givers.
Most people seem to think that AI will be good for healthcare because it will provide reliable, cheap replacements in many areas, but in truth, the biggest impact that AI will have is in the bureaucratic morass of billing/coding/charting.
It is sad, but it is something about which everyone should be aware.
I have a solution which I posted years ago, but it will never be implemented since both of the power sides in this (insurance and hospital system) would be hurt by it - I don't feel like it now since it would, I am sure, get into the politics that I hope to avoid with this post.
The solution does not lie in either the govt take over of medicine (Medicare drove this to begin with which IS the govt). The solution does not lie in the old healthcare system either. It lies in a couple of specific deregulations (not all or even many deregualtions). maybe another time for that.
It is sad. Be aware of that AI has catalyzed...you will see the result of it in your healthcare bills.
In response, hospitals and healthcare networks and offices have been sending their biller/coders to classes to learn how to maximize billable services to counter this decrease in revenue for the same services.
The insurance industry (this now includes Medicare & state Medicaid programs as well as private insurance companies) responded with more and more charting expectations and specifications (they increased complexity of required documentation - often specifics that were irrelevant to a particular treatment, and not something that a care giver would think about as relevant from a medical perspective. They did this because they understand that in a large aggregate, it will result in more billd being able to be denied payment which will save them money.
The hospital side (by this time, large hospital systems had taken over the industry) responded by taking the clinicians away from their patient care for training sessions in the "charting game" which they referred to being a "quality provider" though it was really about being a "quality revenue maximizer" than a quality care giver. The hospital systems are greedy, and they in turn got very "creative" in finding ways to maximize their income.
The battle has gone back in forth in various ways, with one side gaining a temporary advantage and then the other over the years.
Now, Insurance companies have purchased AI products to sift through all of their care giver's charts to fins any charting discrepancy that will allow them not to pay a bill.
The care giver side has responded by spending gobs of money to purchase AI programs of their own to prepare their charts for submission. Clinicians are also being taken away from even more patient care time to address this issue with training and charting.
The care giver side is presently experiencing new deficits from the AI escalation since the insurance side implemented it first.
Medicare drives the pay scale, standard and trends on the insurance side, while big hospital systems drive it from the care giver side, so the idea that a nationalized govt healthcare solution is not a real fix. The private companies would do the same thing since it would make them money in the short term.
Neither side cares about the patients or care givers.
Most people seem to think that AI will be good for healthcare because it will provide reliable, cheap replacements in many areas, but in truth, the biggest impact that AI will have is in the bureaucratic morass of billing/coding/charting.
It is sad, but it is something about which everyone should be aware.
I have a solution which I posted years ago, but it will never be implemented since both of the power sides in this (insurance and hospital system) would be hurt by it - I don't feel like it now since it would, I am sure, get into the politics that I hope to avoid with this post.
The solution does not lie in either the govt take over of medicine (Medicare drove this to begin with which IS the govt). The solution does not lie in the old healthcare system either. It lies in a couple of specific deregulations (not all or even many deregualtions). maybe another time for that.
It is sad. Be aware of that AI has catalyzed...you will see the result of it in your healthcare bills.