Complexifiers and simplifiers

Neil Baum, MD

There are two kinds of people: those who make things complex and those who simplify. In contemporary health care, patients are looking for simple solutions to complex problems. Also, medical practices are searching for simple solutions to solve the current complexity of managing a medical practice. This blog will focus on the complexifiers and the simplifiers in a medical practice and how to move from the complex to the simple solutions for many of our management issues.

Complexifiers are averse to reduction. Their instincts are to keep things complicated and to reject simple ideas. Often, they think that keeping things complicated maintains their job security. The complexifiers are stuck in the status quo and reject new ideas and new solutions for solving problems. The complexifiers take pride in consuming more bandwidth, more time, and patience than needed, and expect rewards for it.

Simplifiers thrive on conciseness and brevity. Simplifiers never let their ego get in the way of a better idea, improvement in efficiency, or suggestions to enhance productivity. When a simplifier is given a complicated task, they look for the simplest way to achieve what needs to be done. They find ways to communicate complex ideas in simple terms without losing the idea's essence or significance.

In modern health care, various factors contribute to the complexity or simplicity of managing a medical practice.

Examples of complexifiers and simplifiers in health care:

An issue that confounds doctors, office managers, staff, and even patients is the regulatory environment imposed by the government and insurance companies. Health care policies, regulations, and compliance requirements make it difficult to deliver health care services.

The health care industry is subject to numerous complex regulatory requirements, with rules and guidelines from various governing bodies to deliver high-quality, safe, and effective care. Yet it is these requirements that slow the delivery of health care. An example is the necessity for prior authorization (PA) for permission to see a patient, to prescribe medications, order an imaging study, or to proceed with an appropriate medical procedure. As a result, physicians must create prior authorization letters at the end of their day or generate these authorization letters in the evening, which is referred to as pajama time. The time requirement to create a PA is often several hours a week of uncompensated time.

Regulations such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States protect patient privacy and the security of personal health information. Health care providers must comply with these regulations to ensure sensitive data is appropriately handled and is encrypted to ensure that sensitive patient information remains private and secure.

Regulatory bodies set standards for the quality and safety of health care services, facilities, and medical devices. For example, the Joint Commission in the United States oversees health care organizations based on their compliance with established standards.

Regulatory agencies, such as the U.S. Food and Drug Administration (FDA), oversee the development, approval, and monitoring of pharmaceuticals and medical devices to ensure their safety and efficacy. The cost of studies to approve a new drug is more than $1B. This cost should decrease with the usage of AI.

Regulations govern how health care providers are reimbursed for the services they deliver. In the United States, the Centers for Medicare & Medicaid Services (CMS) play a significant role in determining reimbursement policies for these government-funded programs. Proper coding is necessary to receive the appropriate reimbursement for services provided. Many practices will down-code their services to avoid potential audits and penalties if their documentation does not meet the requirements for the billed codes.

These regulations pertain to the licensing, credentialing, and ongoing education requirements for health care professionals to ensure they possess the necessary qualifications and skills to deliver care. The credentialing process for a new physician can take four to six months, and as a result, the new physician cannot bill for their services.

With the growing adoption of telehealth and digital health technologies, regulatory frameworks are evolving to address privacy, security, and quality concerns specific to these platforms.

The take-home message is that the complex regulatory environment in health care creates both challenges and opportunities for providers. While compliance can be resource-intensive, time-consuming, and expensive, it is essential for promoting high-quality care and protecting the well-being of patients. It is a veritable nightmare for practices to stay informed about relevant regulations. This is an opportunity for simplifiers to find methods that protect the patient but not bury the practice in a mountain of complex regulatory requirements.

Let’s welcome the simplifiers

The holy grail of interoperability remains elusive. Other countries such as England, France, and Germany have solved the interoperability enigma. Why can't the U.S. health care system do the same? Seamless data exchange between health care systems and providers would streamline care coordination and improve decision-making. It is a difficult pill to swallow knowing that other developed countries achieve interoperability. Still, the U.S. health care system can't accomplish this.

Organizing care around patients' needs and preferences can enhance engagement, satisfaction, and outcomes while simplifying care delivery. For example, a frequent patient complaint is difficulty gaining access to the practice. This often necessitates patients going to urgent care centers for acute problems. This issue can be simplified using AI technology to effectively schedule patients 24/7 so that patients do not need to wait weeks or months to see a physician.

We need to simplify the measurement of outcomes and find methods to measure the quality of care. We need to transition from a system that focuses on volume of care to one that emphasizes quality of care. We need to encourage more efficient, effective, and coordinated care, with patients' interests taking priority over physicians' interests.

Since the pandemic of 2020-22, we have learned that we can offer patients good medical care in many instances without the necessity of having to touch the patient and see them in the office. Still, we can provide care using remote care delivery via telehealth platforms. As a result, we can make health care more convenient for patients by simplifying access to care.

Harken AI to simplify the delivery of medical care. AI-driven solutions and automated processes can help reduce administrative burden, analyze data, and optimize workflows, ultimately simplifying various aspects of health care delivery. The time has arrived to implement AI solutions. By leveraging AI as a strategic approach, rather than just reducing administrative burdens, we can deliver high-quality care more efficiently and provide decision support for treatment pathways based on robust data.

Bottom Line: Identifying and addressing complex problems and embracing simplifiers is crucial for optimizing health care systems and improving patient care.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.