The Day It Hit Me Just How Messed Up the Healthcare Industry Can Be

The other day I learned about a product called TRACKer Pro, and this is when it hit me just how messed up our healthcare system can be sometimes. The product’s description on its website (ractracker.org) pretty much tells the story:

The TRACKer PRO solution is a dynamic web-based technology that provides hospitals with a powerful solution to effectively manage the time-sensitive and complex workflow and documentation requirements needed to satisfy RAC record requests, process determination letters and navigate the multi-tiered rebuttal and appeal process.

In healthcare we have an entire industry with multiple layers of consultants, contractors, and apparently even software solutions, all designed to avoid getting RAC audits, manage the process of getting RAC audits, and now manage the workflow of managing of the process of getting RAC audits.

Unfortunately, this is just how our healthcare system works some days. Instead of actually solving a problem – in this case the miscategorization of patient level of care – we create tools to circumvent the problem. But eventually that tool inevitably breaks down, falls short, or reveals its shortcomings, and so therefore we develop another tool to fix that tool. Then we hire a consultant to manage the fixing of the process and buy a software solution to manage workflow.

I guarantee you there is a contractor or a consulting firm or a software company out there whose job it is to upkeep or implement the software that manages the workflow that is created by consultant we hired to manage the process we tried to avoid in the first place by hiring a different consultant, who we wouldn’t need anyway if we had actually solved the underlying problem.

Every single hospital in America today is grappling with how to correctly categorize its patients so as to avoid all this mess. (In order to cope with the underlying problem, hospitals really should be taking a serious look at starting a closed observation unit to separate out certain types of patients from the general populations. Closed observation units can have a significant impact on lowering a hospital’s risk of RAC audits, not to mention a dramatic reduction in length of stay.) In the mean time, though, how much money are hospitals spending simply because we can’t properly determine whether someone is inpatient or outpatient? This is money that the hospital ultimately is billing to patients, the government, and private insurance companies, after all.

The sad thing is, there are a million problems in healthcare just like this one. Underlying problems aren’t dealt with, and entire industries rise to help manage them. One joke about ACOs is that the acronym actually stands for “Awesome Consulting Opportunities.” Some may blame burdensome regulations on this state of affairs, but usually the regulations are just a flawed government’s best attempt to force fixes and changes on a system that is infinitely complex and difficult to rearrange.

The industry that has grown to deal with RAC audits is really an emblem of a bigger reality: it’s time to start focusing on underlying problems and stop simply trying to consult, sub-contract, and workflow our way out of them.