The Current Dilemma with DME Documentation Needs
Medical supply companies who provide all types of HME or DME products to patients face a slippery slope when it comes to compliance regulations.
The regulations for documentation for proving necessity for an item can be rigorous and complex, and if not careful, suppliers can find themselves in precarious situations with the Center for Medicare/Medicaid Services (CMS).
Inner-company conversations can go something like this between compliance officers and their sales and/or operations officers….
How does the healthcare industry solve this simple problem when the government has determined it illegal for these entities to communicate to each other what’s required?
Who Ultimately Suffers in this scenario? The Patient.
Physicians first and foremost want to solve the problem for the patient. They want to give the best plan of care and don’t care about the administrative questions that the payors are requiring.
The government, payors, and suppliers should be able to assist in guiding the doctor to ensure they answer the compliance questions required of them.
While this may seem like a “small” problem among the hundreds of inefficiencies inside healthcare workflow sector, it’s a HUGE problem for the 4,000 out of 6,000 medical supply companies that have gone out of business over the last 10 years due to situations like the illustration suggests.
The problem is growing and there is no solution in sight.
So when does a real solution become the top priority for payors?
Ken Blancherd in his book “One Minute Manager” gives an excellent bowling analogy that accurately describes the current documentation predicament… Blancherd compares goal setting in the workplace to bowling with a sheet in front of the pins.
Often times goals for employees aren’t clearly defined or given, causing confusion and uncertainty whether the employee hit the mark. This would be similar to a bowler unable to see his pins behind a sheet. He would hear the pins fall, but be unsure how many fell.
In sports, the immediate feedback of scoring points, hitting a bullseye, or earning a strike lets the athlete know right away how he or she did. There’s no third-party to report or interpret the score.
There needs to be just as much clarity in goals and objectives in the workplace as there is in a bowling lane without a sheet in front of the pins!
Change is Inevitable!
Applying this to the dilemma at hand, payors should implement some of these simple techniques such as telling the industry what data points are absolutely necessary to receive an approved invoice, then the industry would switch from a bottom-up regulatory and policy approach to a top-down approach.
A top-down approach is a much more efficient and painless process.
Most people within the healthcare industry genuinely care about what is best for the patient. Focus needs to be patient-centered with clear guidelines medical companies and providers can follow.
Many think a single-payor system will solve the problem, as this would ensure all data to reside in one place, on one system.
But could that actually solve the problem?
The answer is NO!
To solve healthcare’s operational, regulatory, and management problems, the healthcare industry must be viewed as a global community needing a global solution. The issues won’t be solved through a single product or service.
The answer is through a secure platform that is managed, controlled and built by those using it (payors, providers, servicers, and patients), versus playing the “Telephone” game between Subject Matter Experts (SMEs) to engineers who don’t actually understand the specifics of what is needed or wanted by industry leaders and SMEs.
So where do we go from here?
Every entity and everyone must focus on changing the process and start learning and understanding what an agnostic platform with an immutable data process can do. An agnostic platform will allow for anyone to connect, validate, and follow workflows.
This the only way healthcare will truly reach efficiency standards that other industries experience…..and from there it will start to change the world!
At HealthSplash we believe we have a solution to this problem. You can learn more about how it works and how you can get involved on our homepage at HealthSplash.com