Is there anything about “SINGLE” we could like?

As I write this, the latest version of Republican health reform has been halted. The Graham-Cassidy-Heller-Johnson bill (H.R.1628) was officially declared dead and next steps are all guesstimates.

It might be a coincidence that the bill was pulled and Senate Republican leadership decided not to bring the bill the floor for a vote just a day after CNN broadcast a debate between Sen. Bernie Sanders (D-VT), Sen. Amy Klobuchar (D-MN), Sen. Lindsay Graham (R-SC), and Sen. Bill Cassidy (R-LA) on “Obamacare”, CNN Debate Night: The Fight Over Obamacare; and a week after Sen. Sanders introduced the so-called “Medicare for All” bill on September 13.

More than once the CNN debate devolved into an argument over the Graham-Cassidy bill vs. “single payer” health care. But notably, two audience questions (one from a Republican and one from a Democrat) asked the Senate debaters to say what they would do immediately to lower the cost of premiums.

Usually the word “single” in health policy circles makes people think of “single payer.” In my opinion, there is not much possibility with the current Congress to pass a “single payer” bill that would create a nationalized health insurance and health provider system, but I do wonder if there is anything about the concept of “single” that could become policy. Here are two ideas: 1) A “single set of forms” and 2) A “single health IT system.”

“Single Set of Forms”

First, a single set of forms. Could Congress agree to pass a law that would require all insurers, payers, pharmacy benefit managers, etc. to use a standardized set of forms for everything from enrolling in a plan, to requesting a prior authorization for a prescription or medical procedure, to receiving a bill?

The concept isn’t new. Administrative simplification has been a buzzword off and on for more than a decade. Savings from reducing “billing and insurance-related” costs are substantial. A study in 2014 estimated, “A simplified financing system in the U.S. could result in cost savings exceeding $350 billion annually, nearly 15% of health care spending.”

Other studies have attempted to quantify exactly how health care providers waste administrative resources because of the multiple systems they must navigate in order to serve patients. For example, a typical physician might spend 3 to 4 hours per week interacting with health plans, other health care staff (e.g., RN/MA/LPN etc.) might spend 3 to 4 hours per physician per day, and clerical staff might spend 6 to 7 hours per physician per day interacting with health plans. Of the administrative activities involved, the majority of time spent is getting authorizations from health plans to perform services and navigating drug formularies.

A stark and oft-cited example is the Duke University hospital system that has three hospitals with 957 beds, but 1,600 billing clerks. Hard to think that a single set of forms – even if you have multiple payers – wouldn’t be a great way to save money in the U.S. health care system. Seems like “single” when it comes to “single set of forms” is an idea many people could support.

“Single” Health IT System

Second, a “single” health information technology (HIT) system might be a kind of “single” we could like in health care. Recently, the longtime CEO and president of the world-class health care delivery system Cleveland Clinic, Dr. Toby Cosgrove, appeared on Meet the Press Daily to discuss the Graham-Cassidy bill. Most of his comments were focused on ways to improve the current health care system, and one of his top ideas was to make health IT systems interoperable. He would certainly know.

A study from WestHealth Institute in 2013, The Value of Medical Device Interoperability, estimated more than $30 billion could be saved annually by making medical devices “talk to each other.” This seems obvious but the graphic below from WestHealth shows what is typical HIT in a hospital.

Sharing information from one device to another or between devices and the electronic health record (EHR) in a “consistent, predictable and reliable way” that allows clinicians to act upon the information would not only save money, it would also save lives and reduce negative outcomes. Lack of interoperability causes adverse events such as drug errors and diagnostics errors. Keep in mind that about 250,000 people die every year from medical errors. It also impedes clinicians’ abilities to prevent events such as pneumonia caused by ventilators put in at the hospital or postoperative shock.

Why does the word “single” in health care carry such negative connotations? Maybe because most parties—consumers, doctors, hospitals, and plans—don’t think a one-size-fits-all approach will work in this country to address such a wide set of needs when it comes to health care. But the downside to this stigmatization is that the word “single” has become so politically loaded that just uttering the phrase is often enough to stop a conversation that might otherwise turn into useful ideas for reforming our current health care system.

Maybe it’s time to focus on some good ideas for the word “single”—ideas that would truly benefit our large and diverse country. Administrative simplification and interoperability seem like a good place to start.