Unfortunately, Jon, that’s what Health Care is Like

In the past year, for my full-time job, I have been working with my coworkers to upgrade our electronic claims processing capabilities to the ANSI X12 837 data format, which is in EDI. Most of you know that I’m a big fan of XML over the legacy data formats, and in agreement, my team has bemoaned this project as a necessary evil. Unfortunately, the data format isn’t the worst part of working within the health care system. The worst parts of the health care system are the business processes and rules, which are never 100% true, meaning that a software system has to always be flexible enough to handle the exceptions. This is a problem when you are trying to enforce standards and best practices.  This also means that we will forever be stuck in a paper-pushing world until standards are designed AND enforceable by law.

For example, if a home designer designed a bathroom, and the home owner said “I work from home, and am the primary user of this toilet. I always use the lever to flush the toilet.” The designer finds a standard toilet and installs it in the bathroom. Then the home owner’s wife sees the toilet and says to the designer, “Oh no! It can’t work this way! I use the lever to turn on my sink.” To anyone, this sounds ridiculous. Who uses a toilet lever to turn on a sink? This is akin to how outlandish the insurance payers’ exceptions are that we have to handle in electronic claims processing. We all say “They’ll do anything to deny a claim”, and this couldn’t be more true. They will impose as many exceptions as possible, including not implementing and upholding nationally recognized data standards and identification codes (hopefully more on this later).

Now imagine a complex system where, instead of just the home owner and wife, we have 2000+ insurance payers, 300+ million patients (approximate population of our country), and who knows how many doctors (providers) we have to design for. Try to build a system that accommodates all of these stakeholders, and caters to the insurance payers whimsical ideas of using the toilet lever to turn on the sink.

So when Jon Stewart from the Daily Show scoffed at the Republican side of the debate, saying that their images of insurance business processes and diagrams are “scary looking disingenuous health care reform pop art” I felt compelled to respond. I’m sorry to tell you Jon, that’s what health care is like.

Disclaimer: I’m all for the ethos of universal health care reform, and I believe our country can get there. We just need to give our politicians the time to do their research to come up with a plan that really works.

A Solution for Child Overweight

Anyone that knows me knows that Child Overweight is a passion of mine.  Having grown up overweight myself (I peaked at 173, 4’10″ at the age of 14), I find it so heart breaking to see child overweight spreading around the country.  I know the consequences can be attributed to American culture and consumerism, as well as socio-economic status, micro-cultures and race; I know these things from my own research in developing a product for overweight children.  You can read the paper here.

I battled through many hard ships (sorry, no pics, this was before digital cameras) to be the person that I am today, but it sure was not easy.  I, thankfully, had the help of financially-able parents who were able to send me to Camp Pocono Trails. I also was able to join the tennis team and the wrestlerettes in high school, and eventually obtained my Group Exercise and Personal Training certification from AFAA.

So in today’s NYTimes there is an article about 12 year old Tiffany that won an essay contest so that she could attend CPT free this summer.  She’s lost almost 50 lbs, and that is fantastic for this 5’0″ 300+ lb little girl.  My heart really goes out to her, because no matter how overweight any child is, the emotional and psychological affects of growing up overweight can be so hard to shed, even until adult life.

But the question in the article is really about whether the government or health insurance should subsidize camps like CPT.  And, as an alumni (both as a camper and counselor), my gut reaction is not a resounding yes, but a tentative maybe.  I say this because while I turned out okay, I have seen way too many campers who have not.  If you have watched the MTV specials on CPT, you know that many campers lose weight in the summer, only to gain in back during the year, so that they can repeat the cycle again next summer.

It’s possible that campers that take this camp for granted are also those that know their parents can afford to send them back the following summer.  So campers like Tiffany might not gain the weight back. because they don’t know for sure if they can come back next year.  But that is really dependent on the transition her mother facilitates for her upon her return home and back to school.

A friend’s sister went to camp while I was a counselor, and she worked very hard to lose the 20-30lbs she lost in the 8 weeks she was there.  Her parents obviously sacrificed a lot to send her to camp (it is very expensive) but I couldn’t help but drop my jaw when they picked her up with a trunk full of sugar-filled Snapples.  I said to the mother, who was overweight herself, “Why do you even have that around your daughter?” and she said “This is for my husband, not for my daughter.” The parents can really make or break the future success of weight loss for their children.  To add to this, no one, fit or naturally thin, should be drinking sugar filled drinks!  But, believe me, I have many more stories just like this.  How can parents think a young teenager can self regulate and restrict?  It’s only bound to create more problems.

When I look back at my journey as a child and teenager to try to lose weight, I can’t help but think that if I was only made to commit to a sport league when I was younger, and if my family ate more consistent and healthy meals together, that the food and weight would be less of an issue. In our research, my team and I found that children want to be active, they really do.  But, in our age of video games, tv and movies, and where parents are using these to babysit their children while they do other things, the thought that our children want to be playing and to be active seems revolutionary.

So while I do think government subsidies for programs like weight-loss camps or dance-dance revolution for gym class are important for the immediate future, I think that with an “all hands in” mentality, families can help their children succeed in a much cheaper and easier way.