Texas Tech University Health Sciences Center
CEO Minute: Is There a Better Way?

CEO Minute: Is There a Better Way?

CEO Minute: Is There a Better Way?- image0It is one of those good news/bad news things.  I am talking about a recent study released by Center for Health Workforce Studies at the University at Albany, which concludes that health care jobs will grow twice as fast as the general economy, with an additional 4.2 million jobs by 2020.  That’s the good news — especially for those whose role it is to produce more health care providers. Imagine, nearly one in nine U.S. jobs will be in the health care sector by 2020.

However, the bad news is what this says about our collective ability to control costs and deal with escalating demand for services.  If we do create an additional 4.2 million jobs by 2020, it will be expensive to society.  And, if we take the same approach to health care delivery as we have for the 75 years, I suspect the predication is close to correct.  But, is there a better way?  I am not talking about preventative medicine and such today… no, I want to talk about something more fundamental.

The study suggests a number of these jobs will be with insurance companies (that often contract with governmental entities to provide claims services). Not the largest segment, of course, (and not to pick on insurance companies too much); but, could we not wrest some expense out of filing and paying claims?  As we all know, the process of billing third-party entities for health care services is laborious and time consuming — both for patient and provider.

According to a recent Health Affairs study, physicians expend about 12 percent of their net revenue to cover billing.  The report also says that up to 12.6 percent of submitted claims are initially rejected based on nonclinical grounds (although 81 percent are eventually paid). I was in our business office the other day talking with Jeniene King, and she was explaining working denials to me.  I picked up a claim and asked, “What is wrong with this claim?” She said, “It has an extra blank space between the first and last name.” Really.  I know computers are exacting and data has to be in the correct field, but a claim would have been denied by Medicare (our internal editing system caught it first), not because we had the wrong name or the wrong Financial Status Classification, but because it had an extra blank space between correct names.  If these are the types of jobs being created by insurance companies (they need more people to deny legitimate claims to providers), I go back to my earlier question, is there a better way?