ABC Coding Solutions launches eClaim.biz

 By Edward Johnson, PhD , President ABC Coding Solutions

Monday, May 21st, 2007

A Note to US Health Care Practitioners - After years of coding and system development, legal logic research, wrangling with our federal Department of Health and Human Services, and politicking, ABC Coding Solutions has launched eClaim.biz, the tool that ties together the code and logic into a seamless system.  

ABC has done their share of work to help you; now we ask you to step up to the plate and help solve our US healthcare crisis. You are trained, you are experienced, many of you are licensed – why aren’t you part of the solution? 

Practice your profession and compete! You know your profession, but to compete on an uneven field, note: 

First, step back and observe the national debate on our healthcare system and the crisis of rising costs with lesser quality. There are at least two historical forces at work and as they work, we, the American public, feel helpless and may conclude the healthcare crisis cannot be fixed and that the status quo is acceptable.   

One force is Shock and Dismay to make you angry, but powerless. Our news stands and airways are constantly flooded with inflammatory stories of reduced coverage, higher costs, and mediocre results. The headlines focus on the harm being done to those of us who need healthcare the most such as children, the poor, the obese, diabetics, Hurricane Katrina or Greensburg tornado victims, and Iraq veterans! 

Watch and beware because this is a competitive press and public relations system at work. The first news flurry is often about a non-creative knee-jerk bureaucratic response to a budget cut. The bureaucrat is faced with a budget cut, in order to ultimately avoid it, he or she proposes to eliminate a high visibility program, like healthcare coverage for poor children, because the hue and cry of those affected make the budgeters look for another, less vocal target.  The process is so well worn and successful, that it has a name, “gold-watching”. Bureaucrat financial lesson number one is when faced with a budget cut, propose to eliminate your most important program; in other words, put your “gold watch on the table” and the cut will never happen! 

In State of Fear, a fictional novel, Michael Creighton wrote about the role of the press in the national debate about global warming. It is a very controversial book because it questions global warming and a major theme is that the press has manipulated the public with shock and dismay because the press thrives on and profits from it! As an aside, it is the only fictional novel by Creighton that is well documented with footnotes.    

Another force is the Inertia of Status Quo also known as “circling of the wagons”. Every proposed healthcare solution is physician, pharmaceutical, and hospital centric. Open forum discussions are limited in creativity and scope. Even after seemingly open and free debate, final decisions in favor of status quo are made in the back room (i.e., Nevada State Senate Bill S360 that supported healthcare freedom of practice and choice and healthcare transparency did not make it out of committee even after vigorous and wide public support). 

Watch and beware because the healthcare system status quo and the healthcare crisis exist because many people are making a lot of money from it!  But ask yourself, “How did we get into this crisis”? By definition, this is a crisis in the status quo; status quo caused the healthcare crisis; do not expect status quo to solve it. 

Status quo made the field of competition uneven and many of you practitioners have felt the impact of “circled wagons”.  For example, even though licensed, your scopes of practice are under assault in many states.  All non-physician providers feel the constricting power of federally mandated codes that do not meet market demand and prevent easy unencumbered billing and reimbursement.   

In the 1970’s during the Carter administration, our economy was in “stagflation” which was financially very uncomfortable for most Americans. Prices were going up and the economy was not growing.  In our current crisis, healthcare costs are going up and we are not getting better services. After President Carter left office, President Reagan and Paul Volcker, the Chairman of the Federal Reserve Board, revved up the supply-side economy. They did something different and classic capitalism thrived. It is time to eliminate healthcare stagflation by doing something different. 

Our government is not capable of doing something different and thus solving our healthcare crisis; it participates in shock and dismay and it is the status quo.  Notably, there is a general, perceptible, and resigned attitude from some federal and state legislators and staffers towards Health and Human Services (HHS); specifically, their observations are that HHS is too bureaucratic and has too many challenges to solve problems creatively. Collective wisdom and guidance is to work with other departments that have to solve the healthcare crisis quickly and on their own and ones that are not bogged down in status quo. The list of other departments is illustrative – Department of Defense, Bureau of Indian Affairs, the Veteran Administration, and state departments of human services (as opposed to health and human services). Perhaps in recognition of the federal government’s inability to solve the problem, Congress authorized and appropriated federal money to go from HHS to fund state projects intended to experiment with solutions.  

We can solve our healthcare crisis by respecting the power of shock and dismay and status quo and putting our faith in the power of capitalism.  You are the supply-side of healthcare business. No one reacts quicker to an opportunity to make money than American businessmen and women. Let classic capitalism work freely. If freedoms of healthcare practice and choice and healthcare transparency result in better and cheaper healthcare, the American public will demand them. If new or even status quo businesses conclude that they can make money with these freedoms and transparency, they will provide them with or without government action.   

For analogy, global warming is another subject or crisis area of which the American public is aware. Did the U.S. Government lead the nation’s response to a global outcry (Kyoto treaty) – NO! Instead, the American public decided that energy conservation and reduced emissions are in their best interests and American business has responded to meet the demand. Now, even as our federal government remains inactive, states are leading the way with new legislation and our buying habits are changing (for example, we are buying new florescent lights instead of incandescent lights). Businesses are profiting from being “Green” and are selling “Green”. Make healthcare freedoms and transparency the new Green. 

ABC Codes concluded a long time ago that they would provide freedom of healthcare practice and choice.  Their codes and eClaim.biz are tools to empower you to be competitive and they need to be used.  What might the impact be? ABC Codes and eClaim.biz are innovative technologies that will solve the healthcare crisis (see Dr. Clayton Christensen of the Harvard Business School and author of “The Innovators Dilemma” and “The Innovators Solution” in a interview with Mark Smith from the California HealthCare Foundation).   

ABC Codes and eClaim.biz are not only business tools that make an individual practice more effective, but when used broadly, they will collectively provide over time and use something of great value to the business of healthcare and to non-physician professions – data on cost and effectiveness of treatment.  Accurate data will finally allow the non-physician provider communities to compare cost and effectiveness scientifically.  

When was the last time this nation rose as one to meet a challenge successfully? Maybe it was as long ago as World War II, 1941 to 1945.  Picture Rosie the Riveter in a bandana flexing a bicep as she, the representative of millions, does her share of work in a munitions factory. Well, I propose the millions of healthcare practitioners who are under represented are the only ones in our nation that can rise to the healthcare crisis and beat it. ABC has laid the groundwork.  No one else will step in to solve the problem.  Your time is now. 

Edward Johnson, PhD - ABC Codes - Edward.Johnson@ABCcodes.com