United Healthcare is battling with hospital groups across the country in order to make sure that the insurer is notified within 24 hours of a patient’s hospital admission. While most health insurance carriers want to be notified right away when a patient is hospitalized, United Healthcare has taken it a step further by threatening significant reductions in reimbursements if the hospitals fail to notify them within 24 hours of an admission. The battle has gotten heated, with hospitals claiming that the penalty (which could amount to a 50% reduction in reimbursement) is too stiff for what they call a clerical error.
I can see both sides of this issue, but with all of the technological advances we’ve made over the last decade, it seems that something as simple as communication between hospitals and health insurance companies regarding patient admissions should be a simple, electronic process by now, with no clerical errors or staffing issues involved. If astronauts can update their status on Twitter from the space station in real time, we should be able to devise a system that allows for instantaneous notification for health insurance carriers when an insured is treated or admitted to a hospital.
What if our health insurance ID cards came with barcodes that could be scanned in the doctor’s office or hospital, immediately allowing the office staff to see our benefits, how much of our deductible still needs to be met, and any exclusions on our policy? Then admission and treatment data could be transmitted directly to the health insurance carrier, without the need for phone calls or extra staff. Rather than having different scanners and transmittal systems for each insurance carrier, it would make sense for this to be a standardized system, with one system that would be able to transmit data to all of the major health insurance carriers. This isn’t a far-fetched idea – think of credit card processing systems. Visa, MasterCard, American Express and Discover are privately-owned companies that are fiercely competitive with each other. Yet a store owner does not need a separate processing system for each card. When you pay at the gas pump with a credit card, the processing system can identify what type of card you’re using, transmit the data to the correct company, check to make sure you have available credit on your card, and authorize the transaction, all within a few seconds. Visa doesn’t have to wait around for 24 hours before they find out that I bought some groceries today.
There has been a lot of talk about bringing our medical information system into the 21st century lately, and this battle over notifications is a perfect example of how the health care industry is lagging behind a lot of other sectors in terms of electronic data storage and transmission.
