Bob made a couple of points I found interesting, one of which was relevant to my first comment - big data - what's the problem? A statistician/medical researcher would say "false positives."
The other comment I found interesting was that upon finding a certain set of possible factors indicating potential readmission problem, assign a care manager to shepherd the patient through how to avoid having the problem get worse. The analytics department then should be looking for patterns and developing simple decision rules. I think that is part of his middle road - moving toward something operational that the managers and doctors (and others) can use easily.
I had an entirely different take on the translation problem. For me the translation is from the "analytics speak," coming from statistics and other approaches, to the language of a manager. When someone tells a manager that there is a "significant" relationship between variable x and variable y, the manager could be forgiven for saying (to him/herself) "So what? How does that affect what I do this afternoon and tomorrow?"
Waqas. Most of the major hospitals in the US have access to translators for many types of languages, often in an on-call basis. However, I can see how that can be a challenge for smaller hospitals or those in nations with limited resources.
I think insurance companies have an important role to play. They place an inherent control over hospitals because if they don't perform well, patients will suffer and in result, insurance companies will suffer. When these issues become common with a particular hospital, insurance companies may put the hospitals on 'not recommended' or like list.
@Joe yes, I then took my son to a different doctor for his checkup and was pleasantly surprised that this doctor called with results, and then called again just to ask how he's doing, etc. The other doctor was never available because during office hours he was too busy to call back and after office hours, his service wouldn't put you through unless you said it was an emergency. It was very frustrating when I waited a full day for lab results and he only finally called in the evening.
Ariella, the problem worsens in countries where there is a large number of population that does not speak national language. Anyways not being able to comprehend what patient can itself to a medical disaster of the patient.
On translation: I couldn't believe that the hospital my son was in couldn't even get a competent Spanish-speaking person for his roommate who didn't understand English. They claim to offer services in a whole bunch of languages, and you'd think they'd be able to manage Spanish. I'm sure some of the nurses are bilingual, but none of those were assigned to that patient.
I think as long as patient does not get involved in the billing process till the payment step, the insurance company should not be concerned about any fraud risks. If insurance company requests for a report from a doctor, they cannot expected to challenge the report so why request in the first place. If insurance company hires a doctor for second opinion so that major operation cost are avoided, then it does make sense.
A doctor we've seen says insurance companies demand reports from him when they notice patients coming to ERs repeatedly. He didin't say it ever resulted in finding a particular trigger, though. It seems to be more about avoiding the high costs involved with ER bills.
FWIW, this reminds me of a conference I went to wherein a guy who worked as a clinical researcher at a hospital discussed how they were able to enrich their data and research by getting data from a hospital's greatest data store: the billing department. ;)
Generally, the way they say to prevent costs from escalating is with preventative care. But that doesn't work for all cases, as I found out when my son had not one but two spontaneous pneumothorax attacks last year. The only way to prevent future attacks is with surgery, which is a huge expense in itself. What is partiuclarly interesting is that the suregeon's practice billed about half a million dollars all told for the 2 surgeries (one on each side of the lungs) followed by their popping in while he was hospitalized. Insurance disallowed over 90% of the amounts. For example, the PA alone billed just under $10K for his 5 visits at the hospital. The insurance allowed just $250. But here's the thing: we chose a hospital and surgeon that was on our insurance and then they sent people in the practice who are not affiliated. As a result we get stuck with bills for "out of network" care when we went in good faith for someone in-network. This is a serious problem that leads patients with huge bills even when they try to do everything right according to insurance protocols.