President Barack Obama called upon America to apply all its innovation to create a moonshot-like initiative to rid the scourge of cancer during his final State of the Union Address, Jan. 12, 2016.
The term "moonshot" comes from a speech given on May 25, 1961 by President John F. Kennedy. He asked America to undertake a space exploration program; landing men on the moon by the end of the decade. Interestingly, President Richard M. Nixon first used the imagery of a moonshot for healthcare in a 1971 speech where he too talked about finding a cure for cancer
Clearly, we're better able to meet the challenge than when Nixon put it before us. However, the point I wish to make with this blend of history and optimism is as fast and far as healthcare goes in research, discovery, procedures, treatments, and cures, that's how slow it moves with to make its operational side more efficient, easy and equitable. Take a stroll through the business office of group practice and you’ll see what I mean. The level of inefficiency, in terms of process and cost-effectiveness, is disturbing.
Twenty million more Americans now have health insurance than before the Affordable Care Act (ACA). And with that the high deductible health plan has altered the arrangement of financial responsibility from the old 90/10 percent insurance company/consumer to a near 60/40 percent split. The result is consumer out-of-pocket will be more than $600 billion by 2019, according to Kalorama Information.
Healthcare costs are hard to swallow. It's why medical bills are the number one cause for personal bankruptcy in this country. We are not a nation of savers, especially as it relates to healthcare bills. A Federal Reserve survey found 46 percent of Americans did not have enough money to handle a $400 emergency expense.
The clinical side of healthcare is driven to do things better and faster, whereas the operational side of healthcare does nothing to be efficient unless the government pays for, or worse, forces it.
In this day of chatbots handling purchase and payment for goods and services, medical practices manage to exist by sending claims to insurers. This is a process that takes days to process by clearinghouses or waiting up to 120 days for patients to mail back paper statements with a payment.
Clearly, as insurance payments are slow to process and patient balances rise, the ability of a practice to maintain financial success, let alone sustainability gets really tough.
Some group practices have realized billing and collections are not core competencies. So they've outsourced the process to revenue cycle management (RCM) firms. However, many RCM firms replicate the processes and, thus, the cycle continues.
Unlike the cable company, a healthcare provider can't prevent you from watching "Sunday Night Football." As such, there isn't much of a reason to pay a medical bill on time, if at all. The 60/40 split means doctors have to get a lot more of their revenue from sources that take more time and expense from which to collect.
Patients aren't deadbeats, per se. However, a study conducted by Citibank that looked at the correlation between understanding a bill and willingness to pay it points to a big reason why patients are slow to pay. The research found that if the bill can be understood, there is no hesitance to pay it.
Even those with fine educations or who work in healthcare don't fully understand what they see on a medical bill. Case in point, me. My daughter had a couple of sport-related injuries. The bill the followed caused my blood pressure to rise. To give me some assurance it was the bill and not me, I showed it to friends. No one got the amount due correct.
Since the bill was not understandable and, more importantly, a payment I had sent in was not showing up, I resorted to placing a call to the billing office. After more than two hours on the phone with a billing clerk the mystery was solved or so I thought. Instead of applying my payment to what was thought to be the current owed amount, a prior balance was covered. Another month, another bill, creating more confusion and frustration.
If the business of healthcare does not become more efficient, easier to understand and deal with quickly, funding the much needed "Cancer Moonshot" will likely be impossible. The clinical and operational sides of healthcare must work hand-in-hand.