In Search of an Accurate Medical Bill…

“Most people use statistics the way a drunkard uses a lamp post, more for support than illumination.”                                                            – Mark Twain

After leaving hospital nursing because I was tired of working shifts, weekends and holidays I became a nurse nerd; analyzing healthcare data.  I was completely captivated and intrigued by its codes, categorizations and patterns.

My first job outside the hospital setting was for a very large group health insurance company and they hired me as a case manager.  It was my job to assist the claims processors in paying on claims that were of a complex medical nature.  I functioned in a variety of ways; one day I would be providing cost/benefit ratios for renting versus buying different health related equipment over the life of a claim or I’d speak with patients helping them with their questions.  This was a great environment for me because I liked the challenge of each situation being different and unique.

Computers facilitated the ease and access to healthcare data and I found myself wishing that I was a programmer.  I was filled with optimism of how this data, now collected in this fashion could one day be used for high quality patient care and excellent patient outcomes.

Twenty five years and several companies’ later, healthcare data analysis still intrigues me.  I had hoped that the computerization of healthcare data would resolve many of the problems that I was looking at initially but, there is still a job to do.  The multiple silos of information all across healthcare providers, insurance carriers and employers still don’t talk with each other and compare notes.  Various self-interested parties use what data they have to support their premise or budgetary need and sadly; I don’t see that end result I had initially hoped for of optimal patient care and outcomes.  Even more bothersome is the lack of healthcare providers and insurance companies to provide accurate, clearly written and understandable medical bills and statements.

The data is there.  Bureaucratic red tape and hyper regulation needs removed.  Tell me how family members feel when they are trying to get someone to talk to them about their loved one and they are arbitrarily told “we can’t share information with you because of HIPAA regulations”.  When a patient returns home they should be able to place their energies on getting better not being frustrated, on hold, and unable to get explanations of health care costs.

Do you agree that health care consumers have the right to receive accurate and understandable medical bills and insurance statements?  Leave me a reply in the box below; enough of us can make a difference.

Nursing Notes:

Science, nursing, statistics and evidence based care; Nursing Informatics combines medical knowledge with technology to improve working practices and information flow for health professionals and patients.  The proliferation of EMRs (electronic medical record) and mobile healthcare apps have evolved quickly in the last ten years.  There is a great need for nurses in this growing and marketable field which is a good thing in any economy.