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"It’s not brain surgery. US Health insurance billing can also be brought into the Internet era”

That is what “Opinionator” Ezekiel Emanuel said in an opinion piece for the New York Times. Ezekiel Emanuel is vice provost and professor at the University of Pennsylvania and a former White House adviser.

In essence he writes that administrative and billing systems are one of the “the biggest money wasters in the US health care system”. The solution:  electronic billing systems. The result: saving $32 billion. In the US Health Care. Imagine that. The EU claims to save €64 over all sectors, based on 100% adoption.

United States wastes over $20 billion in Health Care Billing

Ezekiel Emanuel wrote his health billing experience down:

“LAST year I had to have a minor biopsy. Every time I went in for an appointment, I had to fill out a form requiring my name, address, insurance information, emergency contact person, vaccination history, previous surgical history and current medical problems, medications and allergies. I must have done it four times in just three days. Then, after my procedure, I received bills — and, even more annoying, statements of charges that said they weren’t bills — almost daily, from the hospital, the surgeon, the primary care doctor, the insurance company.

Imagine that repeated millions of times daily and you have one of the biggest money wasters in our health care system.”

Whereas some claim that full electronic health care billing could lead to savings as high as $180 billion (sounds familiar with some EU estimators), he found an estimation from Harvard economist David Cutler much more reasonable: $32 billion. Similar to 32 billion McBurger’s…

A 6 step path to a lot of benefits

The benefits are large and many according to Emanuel:

  • As said 32 billion burgers US dollars of yearly savings. 20% of the savings go to the US government, 50 percent go to physicians and hospitals and 20% go to the insurers (Hang on! What about you and I, do we get a kickback too?)
  • Facilitating anti-fraud measures
  • Ease the administrative burden on physicians and hospitals
  • Improvement of agreed guidelines on how to perform healthcare (not getting this one? See underneath)

To achieve these benefits Emanuel proposes a 6 step process:

  • Determine a patient’s eligibility for services
  • Obtain prior authorization for specialist visits, tests and treatments
  • Submit claims as a doctor and hospital to insurers
  • Verify whether a claim was received and where in the process it is
  • Adjudicate denials of claims
  • Receive e-payment.

Emanuel writes that many other industries have achieved savings by eliminating paper-based billing systems. So he concluded with, “It’s not brain surgery. Health insurance billing can also be brought into the Internet era”

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