Paper Medical Records Are Here to Stay

Seems Permanent . . .

About 14 years ago, I got involved with automating medical claims. For those not familiar with the process, as it turns out doctors still lick stamps and send paper medical bills (or claims) to health insurance companies for payment. Sure they can submit electronic bills as EDI, but many don’t. There are a couple big reasons (and a million small ones) that lots of paper claims are still out there:

– Loose Standards (837 the EDI format is implemented in lots of different ways)

– Addressing / Delivery (imagine a doctor needing a separate phone line for every payer – while it is not quite this bad, it certainly isn’t like dropping an envelope in a mailbox (or sending an email for that matter) and knowing it will get to an address despite the fact that you have never talked to them)

So while the above could be overcome, it is easier in lots of cases to just keep doing what you are doing. When it comes down to it, there is a utility to paper that is hard to beat in the short term. This is a common theme to PaperInbox, but in this case I want to discuss how it applies to Medical Records.

Whether it is industry news or even mainstream news covering the new healthcare bill, people talk a lot about the EMR or Electronic Medical Records. EMRs are slated to give us all kinds of great efficiencies from better care due from access to patient history at point of care to huge administrative savings that come from eliminating clerical work. These are pretty great things and somewhat inevitable in the long term. In the short term, I think something quite different will take place. Continue reading “Paper Medical Records Are Here to Stay”

2 Areas Not To Outsource

Part 1 Here

In my last post, I submitted that today’s outsourcing is not all that different from basic economic specialization.  We can see that due to advances in technology – particularly communications – the pool of places, talent and resources to draw from is now essentially global and nearing limitless.  Often times my customers ask me questions and I have to point out that the question they have asked is not a matter of “can” something be done, but instead “should” it.  That is where these options with outsourcing have left us.

So what areas should a successful corporation focus on?  Obviously those that offer the biggest return in cost savings.  Now those who have done business with me over the years know me to be perhaps obsessive when it comes to focusing on hard dollar ROI and having very little tolerance for the soft dollar pay-backs that are often used to justify technology sales.  That being said, one has to consider all the COSTS including harder to estimate impacts on other areas of the organization.   Continue reading “2 Areas Not To Outsource”

What To Outsource

PART 1: Background

For years now, companies in corporate America have been turning to outsourcing to help improve margins and make their organizations more competitive.  The thing is that the successful stories – the ones that truly deliver on the promise – are the ones we hear the least about.  Conversely, the biggest disasters are told many times becoming modern versions of the warnings to mariners of sea monsters or the edge of the earth over time.

Why hide it?

Well as it turns out, large companies in America have lots of competition looking to tighten the belt just as much as they are.  When a company outsources successfully a particular part of the operation, the only people they would want to tell about it might be shareholders or potential shareholders.  Then again, if it is successful enough, the better numbers should speak for themselves better than any details of their process ever could.  As such they would be only giving their competition a roadmap to re-level the playing field.  In addition, outsourcing can have negative connotations with some customers regardless of the positive overall effect on the product or service they are purchasing.  Better to keep the best stuff under a hat overall in most cases.

As it turns out, there are huge amounts of information available on successful cases of outsourcing things as varied as IT Services, Call Center work, Tech Support, Data Entry, Manufacturing or any number of others.  The problem is that this information is usually generated courtesy of the company providing the outsourcing services.  Predictably they are going to give “case studies” that proffer stories that might as well include cutlery jumping over celestial bodies (ibid Neal Stephenson).

So how is the busy COO or President to know what is best to pursue and what things should be avoided?  My approach to almost all problems in life is to reduce them to their primary and build back up from there.  I’ll try to be brief since most readers understand the background, but the point needs to be made.  Outsourcing is a modern way of expressing a very old concept: economic specialization.  Without economic specialization, the modern world could not exist.  If each of us had to grow our own food, build our own shelter, weave our own clothes, provide our own healthcare, etc. we would have little time left to concentrate on designing efficient engines, packing more transistors on a wafer of silicone or making a beautiful sculpture.  Today’s modern communication and transportation have simply allowed us to take advantage of varied conditions in further away places.  The answer to WHY outsource lies in the very same roots as any economic specialization.

NEXT POST: The 2 Areas Not to Outsource

Weighing Tech Benefits

Heavy Features
Bigger might just mean more expensive

There are reasons I enjoy my work in a technology related field.  One of the most fun is the whole idea of better, faster, cheaper that I get to see new examples of every day.  If you think back a bit, in 1980 if you bought a VCR it was about $500 (in 1980 dollars), the size of a refrigerator, had no remote, no auto-tracking, no stereo audio output and broke if you rewound tapes too much.  Just before they stopped selling VCRs a couple years ago, you could go into a Walmart and buy one with a remote, produced a clear picture automatically, stereo output, was only maybe 4 times larger than the tapes themselves and cost $39 in 2006 dollars!  It was better in every imaginable way and way cheaper to boot.

Continue reading “Weighing Tech Benefits”

A Timely Technology Solution

Now picture 7.3 million of these
Now picture 7.3 million of these

Saturday’s Wall Street Journal had an interesting headline: Massive Effort To Save Mortgages.  The article went into how JP Morgan was planning on targeting 400,000 loans for modification of terms on top of what they were already doing.  It also mentioned some other banks such as Bank of America’s efforts to modify the terms of existing loans in lieu of foreclosure.  The article points out that “…7.3 million American Homeowners are expected to default on their mortgages between 2008 and 2010.”

As you might expect, when banks transact business with other banks, things can be done in a largely electronic environment generating minimal amounts of paper.  Since individual homeowners don’t have systems that hook directly into lenders the process of modifying the terms (mod) of a loan is done almost exclusively on paper.  Things like pay stubs, tax returns, letters of hardship are used to determine what can be done for each loan.  This means that even simple mods may carry 20-40 pages of faxes, mail, etc. inbound to the lender.  Multiply that by say 7 million and you have yourself a mess of paper.

So many times I see companies in Corporate America spending money on technology for the sake of technology instead of a solid Return on Investment like cutting costs.  In this case however, I came across a service that is specifically targeted to handle all the paperwork related to the workout options for these loans.  I put a copy of the PDF for the service on my website if anyone is interested in an overview (full disclosure: I have worked on various projects with this company for over ten years and am not a totally disinterested party).  It is exciting to see how technology can be used to effectively address something that is urgent, timely and expensive without being overcomplicated.

The service is particularly appealing to lenders because they really don’t have large capital expenditure budgets floating around right now.  Instead of a long drawn out implementation and large amounts of money down, they “pay by the drink” if you will.  It gives lenders who are under pressure to mod loans an option other than throwing more bodies at the problem and hope they can keep ahead of the tide.  Essentially it is a way for them to focus on the decision making aspect of the process rather than the menial, clerical and repetitive tasks.

This is technology and efficiency at its best and it is great when it happens.  Do you have any positive / timely technology examples?  Put it in the comments and I will do my best to address it.

Missed Opportunity: Don’t Waste Your Vote!

Part 2

In Part 1 on this subject, I discussed why John McCain is on his “Farewell Tour” of the US rather than out campaigning: he doesn’t clearly stand for ANYTHING. If you have come this far, then maybe you are asking yourself what can be done less than two weeks from the election.

I asked myself that same thing, but before I go into the answer, I will give some background. You see, I am a man without a party. Hanging on the wall in my office is a picture of Ronald Reagan. In my wallet is an ACLU card showing that I have been a member since 2001. In the back of my trusted Moleskin notebook is a copy of the Constitution and Declaration of Independence which I carry with me to every meeting I have. This combination of items is a shock to most people the first time they hear it and confuses some. As I see it, my political views are very simple: I want the government out of my wallet and out of my bedroom. Unfortunately, the Democrats and Republicans don’t match up with EITHER of those things much less both.

Trust the governement to decide non-objective law
Trust the government to decide non-objective law

The Republican Party was allegedly the party that stood for controlling and shrinking the government. Eight years of spending like drunken sailors shreds any notion of that being true. The Democrats on the other hand have had plenty of opportunities to stand up against things like illegal warrantless wiretaps or a railroaded “Patriot” Act and have stood idly by while pretending the Fourth Amendment didn’t exist; so much for the Liberals defending rights.

So since the Democrats or the Republicans don’t have a scrap of similarity to what I hold as values, I will look elsewhere. I am an Objectivist and cannot say that I am a Libertarian, however if I take a look at the Libertarian platform and plans, they dovetail nicely with my convictions regardless of how they got there. The plan can be summed up as “Smaller Government, Lower Taxes, More Freedom”. It hits me like a breath of fresh air.

The argument that I hear a lot on this subject is that people are afraid of wasting their vote on a third party. In 2000 I voted for Bush and ended up staying up for two days without sleeping glued to the TV trying to find out who won. When it was decided, I felt like I was going to vomit. You see, no matter who I voted for we were in for an awful Presidency. I call it the election hangover. In 2004, I listened to Kerry’s promises of endless handouts and spending and then choose John Edwards as his running mate. I knew Edwards as not only a frightening social engineer but an awful human being. It was clear there was no way I could vote for them. Instead I voted for a fellow named Michael Badnarik whose views very closely matched my own. The next morning, I knew that I had stood up for what I believed in rather than accepting my two awful choices. No election hangover. Most people are willing to accept values that are not their own in a candidate with the justification that it was the best of two evils. I am finished with that. I will vote for what I believe in and not give a tacit endorsement to this system that guarantees that you will only be able to choose between two bads handpicked by the lowest common denominator in the country.

The good news is that your option isn’t anything that requires you to accept my position on voting. Instead, I am telling you not to waste your vote. Before you think that is a contradiction, recognize that there is not one reasonable poll suggesting that McCain has a chance to win. A vote for him does not tell the Republican Party anything about why they lost or what they should do in the future. It is wasted plain and simple.

On the other hand, a vote for Bob Barr sends a consistent message: the party has lost its way, but the path is well marked for how to get back on it. If a principled person wants to have his or her voice heard in both political parties, they should vote for Bob Barr. A vote for Barr will be counted as a protest against the Bush/McCain’s (or even Obama’s) big spending policies.

I mentioned in the first half on this subject that both McCain (+$92B) and Obama (+$292B) are planning on massive expansions in spending. Bob Barr’s plan calls for a $200 Billion CUT in spending from present levels. His answers on individual rights and property rights are very clear – keep the government out. Tell your party what direction to go rather than stumble around for the next four year to end up with another patsy.

A Missed Opportunity for the Republican Party

Part 1

In a few weeks, the election will be over and the Republican Party will ask itself where it went so wrong that caused them to be beaten so badly. McCain is a war hero, loads of experience and fairly clean for a politician. What is not to like? I can save some time and clear things up for them. McCain failed to clearly stand for anything.

Maybe We Should Subsidize Fertilizer
Maybe We Should Subsidize Fertilizer

Obama seems to be a good man overall. He is compelling, dynamic and strikes me as someone who believes in what he is saying. The problem is not whether he is a nice man though. At issue is whether he will do a good job with the country. His prescription for how to best fix things: follow one of largest expansions of government spending in the history of the country with an even larger one. If you think that is a good thing or that productive people have a responsibility to work for those who are not productive you can stop reading here.

When the people find they can vote themselves money, that will herald the end of the republic. Benjamin Franklin July 4th, 1776

In any interview with McCain and in any opportunity to spell out his plans, the answer to any question that comes up invariably involves spending more money. According to the National Taxpayers Union John McCain will increase annual federal spending by $92 billion and Barack Obama will add $293 billion. If the race is to be decided by whoever promises the most to the public, McCain is getting beaten badly. At the same time, it is very difficult to put on a serious face about being fiscally conservative when you are saying that you want to increase the budget deficit by 20% your first year in office.

The question is, if McCain is not trying to buy the vote with his fancy promises of fairytale government healthcare (still socialized healthcare, but not AS socialized as Obama’s doesn’t sound that nice), increased privatization of foolish real estate speculating or a myriad of other attempts to take from those who are productive and give to those who are not, then what IS he trying to appeal to voters on?

The answer to why McCain got slaughtered in this election is not that he is old, boring, choose a running mate that talks to her invisible friends or even that he is following an awful president from his own party. The answer is that he does not stand for ANYTHING. There may have been a time when John McCain spoke his peace and stood up for what he thought was right even if it was against the advice of his political handlers. That time is long gone.

McCain’s platform is now a mush of compromises intended to appeal to the most people possible. The result is a plan where any underlying guiding principles or philosophy that he may have once possessed has been obliterated. Trying to appeal to the “average” American who shoves fast food in their face by day and rots their brain at night with American Idol and the like on TV is not the answer to fixing what is wrong with this country. These people will continue to fester and decay and their vote is not what is going to chart a successful course for the country (although it may lead to government subsidized McDonalds in 2012 paid for with more debt and the sweat of the few remaining productive people of this country).

The Republicans have missed an opportunity to define themselves for future generations. Instead of being a party that stood for letting honest men earn and keep the product of their efforts, they grasp onto scaled down versions of the same social engineering experiments the Democrats are proposing. It is as if they are conceding things like “Capitalism doesn’t work”/ “The Free Market Failed” etc. but don’t want to address it as aggressively as the Democrats. Instead of defending the principles that built the country, the Republican’s have given tacit endorsement to having the role of the government be that of a Nanny.

Rather than debate whether the government should be growing at all, the only permissible conversation is how MUCH the government should grow. When you don’t stand for the free market (healthcare, banking etc.), when you don’t stand for personal responsibility (socialize losses from foolish real estate investments), when you don’t stand up for free speech (warrant less wiretaps) and you have no plans to reduce our foreign presence (permanent troops in over 130 countries), what DO you stand for?

Up next: What can we do about it BEFORE the election?