Most healthcare professionals and consumers understand that medical and hospital bills are a total mess. I probably don't need to marshal any evidence to convince the readers of this blog about such a statement. One only needs to glance at some of these personal bills to understand this claim. Perhaps a more interesting topic, though, is why medical billing is in such a state. A recent opinion piece by Elizabeth Rosenthal in the New York Times took up this topic (see: The Medical Bill Mystery) and below are two paragraphs from it that go to the causes of indecipherable bills:
“Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that,” said Mark Hall, a professor of health law at Wake Forest University. “We’ve not seen a lot of pressure to standardize medical billing, but there’s certainly a need.” Hospitals and medical clinics, for their part, often counter by saying that detailed bills are simply too complicated for patients and that they provide the information required by insurers. But with rising copays and deductibles, patients are shouldering an increasing burden.
I called the American Medical Billing Association, a trade group based in Oklahoma, expecting a defense and instead got a kind of mea culpa, from Cyndee Weston, its executive director: “There are no industry standards with regards to what information a patient should receive regarding their bill,” she said. “The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry.
The first explanation for undecipherable hospital bills is rather obvious. Most hospital bills are paid by health insurance companies and by CMS, an arm of the federal government, on the basis of pre-negotiated, highly discounted rates. All of the parties to these transactions are familiar with the rules and the vocabulary used in the field that only they themselves truly understand. Hospital billing professionals can thus interpret the hospital bills of today and, from the perspective of the industry, that's the only thing that really counts. The patient is not even close to being viewed as the customer in the transactions from a billing perspective. Forget about patient-centered healthcare. Also forget about the fact that patients with high deductible health insurance policies are now paying a larger percentage of the bills than previously and need to better understand what they are paying for.
The second reason cited in the second excerpt above is interesting and not often cited in articles of this type. To quote from the director of the trade association called AMBA: The [medical] software industry has pretty much decided what information patients should receive...[and] they have not had any stakeholder input. Yes, you understand correctly what she is saying. The EHR software vendors have designed the hospital billing systems and that's why they are undecipherable. Had they consulted stakeholders, they might be otherwise. Does anyone else see the parallel between the incomprehensibility of bills received by patients and the general lack of utility of the electronic medical records used by physicians and nurses to guide and monitor the care delivered to patients?