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Decoding the biggest problem in healthcare

For health professionals, coding obligations are all consuming. This is because their compensation is in jeopardy if their services are not coded "correctly.” Studies show that healthcare professionals spend up to 50% of their time on these coding obligations. This is time that could otherwise be spent more productively, by talking with patients (or each other) about coordinating care. One major casualty of coding is the loss of quality time with patients. Arguably, coding--and its ensuing monopoly over physicians' time--is the primary cause of fragmented healthcare. The premise of the coding and billing system is that care must be accurately measured before payment is made. Unfortunately, the "care" in healthcare is not always easily or accurately measured. For example, the payment system has eviscerated everything from primary and palliative care to gerontology and mental health, because their services are difficult to quantify. Another problem is that the coding system prizes comprehensiveness and complexity. In theory, such complexity would lead to more accurate billing, but in practice it actually costs more while adding little in terms of value. In fact, there's a massive industry called Revenue Cycle Management (RCM) to deal with all of this. And to put the staggering costs of coding into perspective, RCM generated $140.4 billion in 2022 and is forecasted to grow 10.3 percent annually through 2030. For comparison, the entire US automobile market was $100.9 billion in 2022. That is $40 billion less than RCM. The concern here is clear--that medical claims processing has taken over healthcare, and disrupted the physician-patient relationship in the process. My book, The Journey’s End , explores these matters in detail and offers pragmatic solutions.

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