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by reureu
1050 days ago
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That was what Nuna (nuna.com) was originally trying to do ~10 years ago (put together bundled payments for value-based care models). I think they've since pivoted to more general healthcare data tools. One of the difficulties is that in many systems medical billing is done by coding specialists based off the provider's note. They may recommend CPT codes, but that may not be what's actually billed. In addition, most providers are too swamped to do things like put together an estimate or drag and drop CPT codes. Hell, many providers will literally count the clicks they have to make in an EHR and will LOUDLY let you know if your proposal will increase their number of clicks by even one. I don't mean to be a downer on this, and I do think there are solutions... but I think 90% of the problems in healthcare aren't technological ones but are navigating large, entrenched systems that have very little incentive to change. |
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Having led provider operations and data systems in various settings for the last decade, this is absolutely true. I find a lot of the 'healthcare is ripe for disruption' comments miss that most of the work isn't going to be fixed by some neat javascript or whatever.
To your note on CPT codes, I'd also bet that, if a given provider is seeing ACA or MA patients, their billing systems and payer interactions will also be more complicated, in terms of coding (diagnosis and procedure), in order to satisfy risk adjustment needs. It's effectively impossible to incent a provider to use two entirely different systems, depending on who the patient is.