Chris Thompson wrote:
> So can you explain in more detail how this legislation
> enables the development of specifications that enable
> XML<->X12 translation, or more specifically, who cares?
<rant on>
Since the US spends 1.1 $Trillion/year on health care and about 30-40% is
estimated to be releated to overhead (that's you BTW), that's about $300-400
Billion/year in waste.
That is all of our tax dollars at work, so I suppose we all ought to care.
Clearly you are missing the boat. The problem is all the 'legacy' systems
which don't work. Sure screen scraping is electronic, but that's not the
point. Many providers spend alot of money getting the 'transactions' from
paper (that's where 90% start) into an 'electronic' format in the first
place. Have you ever seen a medical chart? Where do you think the bills
arise? How do you think those paper charts get converted into 'electronic'
transactions? Magic?
Most small physician's offices are charged an average of 10% off the top by
medical billing services. Suppose we were able to take that money and apply
it toward insuring all Americans. The point about XML is that it enables
small as well as large providers to get into the EDI business without
spending an arm and a leg.
>
> We process and send some 200 million health insurance
> transactions a year, so this is not a trivial issue for us.
I'm sure you have a vested interest in keeping the status quo! Ought the
government keep spending our precious tax dollars this terribly broken
system? What XML enables is an electronic medical record system which can
seemlessly link to legacy X12 EDI systems. Furthermore, HCFA will accept
X12, not only from clearinghouses but directly from providers, so when
providers can get EDI enabled they can afford to spend that extra 10% of
their time on patient care and not on billing overhead.
... Can anyone
> show me one single example where a covered entity has to do
> anything different than it is doing today?
>
It remains to be seen how much impact Kennedy-Kastelbaum alone will have,
but consider this: the U.K. spends about 5-6% of its GNP on healthcare and
we spend about 12% (roughly). Our medical care certainly isn't twice as
good. Ditto Canada. This is one benefit of a uniform payment system. Uniform
transactions are merely a step along the path.
</rant>
Jonathan Borden
The Open Healthcare Group
http://www.openhealth.org
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