Credentialing nationally, locally
Your article "Cutting through the paper" (March 8, p. 58) reports on an effort in Massachusetts to reduce administrative burdens associated with physician credentialing. However, state-specific applications can end up adding complexity to a nationwide concern.
In response to the problem, leading health plans have developed a national solution that also works at the local level. Through the Council for Affordable Quality Health- care, health plans are working collaboratively to ease the time and frustration that comes with multiple credentialing and recredentialing applications. The Universal Credentialing DataSource allows providers to complete one credentialing application that is accepted by all participating health plans.
Because the unique, online solution is available nationally, it provides a complete solution for providers who contract not only with local plans, but also payers who operate in multiple states. It is available at no cost to providers, and does not require a second form for recredentialing.
Removing redundancy from the credentialing process is an important step toward reducing healthcare costs and improving interaction between providers and payers. However state-specific approaches provide only part of the answer. Physicians are better served by a comprehensive national initiative.
Council for Affordable Quality Healthcare
Clarifying an outsourcing deal
Thank you for your insightful feature story on outsourcing ("Outsiders get the call," March 8, p. 49). On the whole, it was well-researched and well-written, and we welcome the fact that your publication has opened discussion on the possibilities of outsourcing clinical functions.
However, we would like to correct a few inaccuracies in reference to our client, St. Louis Children's Hospital. Although St. Louis Children's uses our call center technology, the hospital had established its outstanding medical contact center program and grew its subscriber base prior to our relationship.
Although many hospitals and healthcare facilities do outsource clinical and marketing calls to IntelliCare, St. Louis Children's Hospital runs its program exclusively in-house using our efficient technology and its quality nurses. The hospital uses our medical contact center software, IntelliView, but we do not answer calls on its behalf.
Victor Otley III
Chief executive officer
IntelliCare Portland, Maine
Fix this system
Healthcare is broken. All the federal bureaucrats, all the healthcare managers and all the caregivers cannot put it back together again. Although it is broken, healthcare in our country can still be considered the best in the world. If you have an accident or are acutely ill, most of our hospitals and medical staffs will use the latest technology to repair or cure you. The system is best at immediate fixes; broken bones and faulty hearts are mended with unequalled capability. This approach is driven by payments. The most complex procedure-oriented modes of care receive the greatest financial rewards.
Healthcare is not good at solving health issues that are not immediately diagnosable and fixable. Health promotion and disease prevention receive minimal funding from government and payers and little attention from caregivers. Continuity of care is virtually nonexistent for diabetes or other chronic diseases.
Our medical records are strewn hither and yon. There is no shared record-keeping system that assures communications among the providers who care for us. It is difficult to put resources into something that is not encouraged by reimbursement.
The basic financial structures of hospitals and medical practice are untenable, even though healthcare costs have outstripped inflation continually except for a brief time in the 1990s. There is nothing on the horizon that will dramatically change the combination of inexorable increases in health insurance premiums, decreases in benefits and increases in coinsurance and deductibles.
As the Institute of Medicine has noted, up to 100,000 people each year are killed by medical errors. Those killed cut across all income lines. There are clear information systems solutions to stop this carnage, but they aren't being implemented fast enough.
It is time to treat healthcare as a business, not in terms of its mission, but in terms of our expectations of it. We need information systems and data compatibility so that caregivers can communicate with each other and with patients and families across the system. We need evidenced-based medicine to rid the system of unneeded procedures. A shift must be made from acute intervention to prospective and predictive care focused on health promotion and disease prevention and management.
High costs of drug ads
I agree with your editorial on prescription drug reimportation and U.S. drug prices ("It's time to look at Rx pricing," March 15, p. 18). Finally someone has gone to the crux of the high cost of prescriptions in the U.S. and excessive net profit by U.S. drug manufacturers.
Pharmaceutical companies on average operate on a profit margin of 20%. While often citing the dollars they spend on research and development they rarely mention the monies spent on direct-to-consumer advertising and lobbying.
A final irony to the reimportation debate: I have a bottle of Lipitor in my hand, made by Pfizer-in Ireland. I also have a vial of Protonix, made by Wyeth-in Germany.
Director of pharmacy
Insurance companies put profits before patients when they deny or delay diagnostic tests or treatment to patients. They also put doctors at risk for malpractice. Doctors who meekly comply with these denials or delays contribute to their own malpractice liability.
My advice: Doctors who think something is important enough to do in a timely fashion should advise the patient to do the diagnostic test or treatment on a self-procured basis, bill the insurance company and hire a lawyer if the insurance company squawks.
Union of American Physicians and Dentists