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ADVANCE Perspective: HIM

Giving Health Care a Workout

Published November 16, 2009 11:13 AM by Cheryl McEvoy

Ouch.

That's about all I can say (and really, all I can think) after overexerting myself this weekend. A few of my friends have been doing P90 X, an extreme workout plan that includes several videos, each of which features a different routine, i.e. abs, arms, yoga. The idea is to rotate videos so you exercise different muscles each day.

Well, Saturday was yoga day, and I decided to join in. Having done yoga in the past, I was pretty confident I could show the guys up. Again I say, ouch.

It wasn't so much the moves that were tough; barring a few pretzel-like twists, the poses were pretty standard for yoga. But the transitions were faster, with hardly any breaks, so the 1.5-hour video became a grueling test of endurance.

I've always tried to stay fit, but over the past 6 months I've taken what I like to call an extended break from regular exercise. And as I so painfully discovered Sunday morning, I'm out of shape.

It's a harsh wake up call to learn you're not as strong as you thought (and boy, do I have a lot of weak spots). But it's something the health care industry will be facing, especially as hospitals and providers adopt more HIT. Before launching any project, most organizations conduct an impact assessment and determine what areas will be affected and if they can weather the change. With the transition to EHRs and ICD-10, providers may be surprised to find their policies, procedures, systems and support need a revamp-or at least a good stretch.

Even the government is getting a reality check. A recent federal report estimated that $47 million in Medicare payments went to questionable claims, and officials ignored 30 alerts from investigators regarding potential scams. Previous years' estimates had been much lower, with only $17 billion in improper payments reported in 2008. But those numbers discounted payments for claims that had incomplete documentation or illegible signatures, so results were skewed-sort of like watching an exercise video but not actually doing the routine.

Now, President Obama wants to push through the pain with a strict regimen to slash fraud; the goal is to trim improper payments from 12.4 percent to 9.5 percent by 2010, with continued cuts in the following years. And HIM professionals will be right there for the workout, as documentation is expected to come under greater scrutiny.

Most people agree that health care could be in better shape. The tough part is finding those weak points and working them out. It's bound to leave more than a few people sore, but, hey, Advil can do wonders.

1 comments

P90x is tough isn't it?  But on to health care.  Fraud kills the billing business.  It slows down AR and hurts the amount collected on valid claims because so much time and money is wasted on fraudulent claims.  %0d%0a%0d%0aIt is good to see that the government is doing more than just going after the insurance industry to try to help reduce cost in the medical industry.

Adam Mlynarcik, Medical Billing - Supervisor of Computer Operations, Custom Data Services, Inc. November 16, 2009 3:55 PM
Merrillville IN

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