The Medical Paperwork Syndrome

Part of the inertia in correcting the paperwork problem comes from most folks outside of medicine having only a dim awareness of how complicated, how obstructing and how expensive unnecessary paperwork is.

I love that title; it's emblematic of much of what is wrong with medical affairs as they are conducted today.

Most doctors will grunt in agreement that over time their practices have increasingly shifted from predominantly spending time in direct patient care to one preoccupied with forms, codes and other unpleasant minutiae to the detriment of patient care. And other than the current half-hearted and muddled effort to institute electronic health records (that don't speak to each other!) none of the responsible parties involved seem to have a cogent idea of what to do or how to do it to mitigate the mess.

A hospital CEO once told me that 40%(!) of his employees deal only with paper, not patients. And we all know from sad personal experience that all of the others who are involved in patient care are also burdened with paper.

And then there was Congress' brilliant addition of HIPAA to add more paperwork to track our paperwork. I know, I know, "if it isn't written it didn't happen" say the lawyers. Grudgingly, we do have to admit to having seen situations where things were not recorded correctly, timely or completely, for whatever reasons and some of them not good. Maybe improving intent would be a good place to start, rather than just more documentation.

Part of the inertia in correcting the paperwork problem comes from most folks outside of medicine having only a dim awareness of how complicated, how obstructing and how expensive unnecessary paperwork is for doctors, hospitals and, ultimately, for the population that we serve. So there isn't exactly a ground roots movement to change any part of this tentacled issue. And there are so many other contentious situations in and out of medicine that are queued up for the public's and the government's attention in front of simplifying and rationalizing our paperwork.

You would think that the "private sector" would have long since cleaned up their share of the problem in the interest of (yet) higher profits, but they've come a cropper, too. And every time one of my software pals here in Silicon Valley pipes up how computers have eliminated paper I just want to throttle him.

The Wall Street Journal

There is an even further expanse to this paperwork conundrum that was highlighted in recently by Ellen Schultz. One of the reasons medical folks' paperwork is getting such short shrift is that many of our patients are preoccupied and overwhelmed. Not so much the majority who get only casual medical attention, but the elderly, the chronically ill and those confronted with medical catastrophes.

Those of you who have personal experience with these situations on the family side will know what we're confronting here. People and families often do not have the time, the knowledge or the emotional distance that is necessary to wade through and manage these complicated forms and issues. They are dealing with a senior's decline and/or death, during and after the fact, and sudden disasters are particularly thorny.

An entire profession has sprung up to help folks cope with what is obvious to all now; we have a really, really dysfunctional medical information and billing apparatus. These claims advocates, or assistants, as they are known (The Alliance of Claims Assistance Professionals at claims.org) get up to $100 per hour to decipher, resubmit, track, uncover, negotiate and resolve problems that a well-designed system would not have triggered in the first place. You can see why they might lobby to not change a thing. Incidentally there are a lot of doctors who do not net $100 per hour doing the real work!

I've written how it took about seven months for such a situation to be worked through in my own family and have personally seen how families are silently subsidizing the gigantic hidden cost of medical record keeping and dysfunctional billing. This cost is taken for granted and is not even estimated in the growing literature on ever-rising health care costs.

So the American public and the medical profession have an underappreciated, largely unaddressed and hugely expensive paperwork problem on both sides of the tongue depressor. Our utopian fix might be a non-fee based system to eliminate billing altogether, rooted in a secure and shared voice recognition online and/or implanted chip system for data storage and easy, portable access. Maybe our grandchildren will see such improvements effected.

In the near-term there are a few more realistic low-hanging-fruit fixes. Like Medicare declaring in 90 days all doctors and insurance companies will henceforth use one common, simple superbill, managed electronically. Taking this thought a step further, Medicare, being the 400-pound gorilla, could also pick one of the hand-held tablets for doctors now on the market with templates for more standardized online record-keeping and sharing, Wi-Fi prescriptions, scheduling and billing. And incentivize its use.

Hospitals and their immense costs are another story. And the Gordian knot of fee-for-service paper documentation requirements, regulatory paper burdens and quirky local management would seem to require Alexander's Sword.

But whatever ideas we bat about, we can certainly all agree that what we have now in medical billing and record keeping is spectacularly inefficient and is in need of any change that can be effected.