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(Wednesday, May 21, 2014)
Health insurance executives have two major complaints about hospitals and doctors .
1. They overtest and overtreat insured patients, in order to maximize their profits
2. Their documentation is very poor
This is why it’s very hard for insurance companies to check that the medical care which was provided was medical appropriate or not. They are forced to invest a lot of money in fraud detection and utilization review , in order to ensure that the care which was provided to the insured patient was exactly what the patient needed – and not more just because the insurance company is paying for it .
However , as a result of this emphasis on paperwork and forms which need to be submitted to the insurance for processing the reimbursement claims, hospitals and doctors are very unhappy with insurers. Doctors hate filling up forms, because they are more interested in taking good care of their patients and helping them to get better.
This sets up a confrontation , and doctors feel that they are now being forced to spend more time filling out forms , in order to comply with the insurance company’s unreasonable requirements , rather than in taking care of patients . This has now become such a burden, that lots of doctors have started to refuse to accept insurance payments , because of the heartburn and angst it causes them.
One solution to this problem would be that insurance companies should provide their doctors and hospitals with EMRs. This way, data which the insurance company needs ( both to process the claim and ensure that they care is appropriate) will become a desirable side effect of the clinical encounter, during which the doctor is taking care of the patient.
This way, instead of having to separately fill out forms just in order to get reimbursement , this data which the insurance company needs will be automatically generated while the doctor is taking a history and doing an examination.
Hospital information systems and EMRs have now become cloud-based which means it’s very inexpensive for insurers to do so. Because of the advantages of scale, they can do this very cost effectively .
This creates a win-win situation for everyone – the doctor, the patient and the hospital. The doctor and hospital are happy because they can provide better care using the latest medical technology , without having to spend for it from their own pocket.
It’s good for the insurance companies , because the medical record system can be designed so that it automatically provides them with the metrics which they need to monitor the quality of care, in order to ensure that the clinical care which is being provided is of high quality . Also, since the data collection is online and being done in real time, the documentation cannot be fudged or manipulated later on. This will also help to reduce fraud.
Patients will also benefit, because they can access their own medical records online , through a patient portal ! This will empower them because they now have instant access to their medical details, 24/7, no matter where in the world they are !
If health insurance companies started providing hospitals with online cloud based EMRs, this would help everyone in the healthcare ecosystem .