In today’s day of healthcare, margins have contiued to become razor thin for providers. Any chance to both make a difference for a patient as well as do it in a cost effective way is more and more paramount.
Medicare Physician Fee Schedule
I have posted numerous times about the unfairness and badly outdated Physician Fee Schedule. That monster of a piece of garbage has been the standard for reimbursement for decades. Even though it is the Fee schedule for Medicare reimbursement, most Medicare Advantage and private insurance companies use it and it’s rules as a guide.
The quest for neutrality has been the biggest joke directly affecting the schedule over the years. So short story, those that paid enough for advocating and influencing senators and representatives, would get adjustments made to the billing codes they use the most. Unfortunately that means that same increase must be cut from another code that another type of provider uses in their practice.
Data capture for efficiency
Here is an area that can be beneficial for a provider and help to offset the ebbs and flows of changing reimbursement rates in the fee schedule. If you can capture data about episodes of care, you can establish protocols. By looking at these episodes of care there are insights as to what worked and what did not work. This can also be looked further into what was the cost versus reimbursement.
By establishing cost effective protocols for treatment of certain conditions it can be a guide for future treatment protocols.
Data pitfalls
Unfortunately data can be a bad thing in some instances of heathcare. When data is assessed to establish averages, we need to remember that when dealing with human beings, they don’t always fit into the averages.
This idea becomes even more dangerous when averages and algorithms actually fully dictate the care someone receives. When dealing with people there needs to be the awareness that data can guide you into the right direction, but ultimately the caregiver and the patient need to assess the results and adapt to changing conditions.
Data purely for profit
There have been instances in the past few years of some companies over using data and algorithms to not only guide care, but establish the exact protocol. Unfortunately some insurance companies have been using data to dictate care. These plans of care have had episodes of traumatic negative outcomes due to premature discharges from services based on data averages through an algorithm.
All too often it has been argued that the strict use of an algorithm for care was unilaterally based on maximal profit versus patient care and outcomes.
Ethical use of data
When looking at utilization of data in the Healthcare setting, it is imperative to remember how important ethics need to be involved. When dealing with Healthcare and possibly life or death moments, data is only a guide and should not replace the education and intuition of a Healthcare worker who has been professionally licensed to make the proper decisions based on the changing conditions of care during a person’s episode of care.
Who has control?
We all need to have and maintain control over our data. We need to be an advocate , not only for ourselves, but also for those around us that do not know or understand what could be at stake. There needs to be government controls and guidelines in place to protect us consumers. We also need to be and stay educated about what data is being collected of our Healthcare, as well as how it will be used. Don’t just blindly accept terms. Be an individual, not a number.
