A Rational Proposal to Fix Healthcare
By J. Melinna Giannini

The U.S. healthcare system can no longer rely on medicine as its primary form of healthcare. Our U.S. medical schools cannot increase the physician workforce fast enough to keep pace with population growth and the needs of baby boomers.

The physician workforce decreased from 772,000 doctors to 633,000 doctors since 2000. Significantly, the U.S. population grew by 50 million people since 2000. Care shortages, dramatic cost escalations and more people without insurance require immediate action.

Our nation can immediately increase care and reduce costs by maximizing direct patient access to the 2+ million healthcare professionals who are authorized and available to manage non-acute patient care.



Rather than routing patients to physicians for non-acute care, we can route them to non-physicians who are legally authorized to manage care without oversight. This minor change in policy will free physicians to better manage acute care, provide patients with timely care and reduce physician oversight charges.

To make this change in our healthcare delivery model, certain government healthcare policies must be modified. For example, Medicare should eliminate its policy of disallowing direct reimbursement to advance practice nurses.

Non-physicians also need an infrastructure to bill public and private insurers for their services in order to:

•  Reduce paperwork burdens and costs for both parties
•  Increase the accuracy and speed of communications
•  Protect providers and payers from fraudulent billing practices
•  Identify effective options to more expensive medical care
•  Help create more effective federal and state healthcare policies

Available Infrastructure
Our company offers over 4,500 codes (called ABC codes) to fill gaps in the medical coding systems required by the government for filing insurance claims. ABC codes fit into the established insurance claim filing and reimbursement infrastructure. ABC codes do not require any modification to current business practices. ABC codes are multi-dimensional and convey layers of information that is not required of medical codes – primarily because physician scope of practice rules are similar in every state.

Unlike physicians, non-physicians are governed by different scope of practice rules in every state. For example, Oregon allows chiropractors to deliver babies while New Jersey prohibits them from prescribing vitamins. The ABC coding system includes over 20 million references (by code and practitioner type) to state scope of practice rules. By helping determine who can do what in each state, the ABC coding system helps practitioners and payers avoid government fines that can be as high as $10,000 per claim (click here to learn more about Fraud and Abuse Provisions of HIPAA.)

Proof of Concept
In 2003, the U.S. Department of Health and Human Services authorized testing of ABC codes (click here to read more about the authorized pilot.)

Under this authorization, ABC codes were field tested in over 1.5 million transactions.

Alaska Medicaid, the largest beta test site, reported a 50% cost benefit by using ABC codes to file claims based on behavioral health care services delivered by 500 paraprofessionals to 4,000 underserved people in bush communities of the state from 2004-2007 (click here to read details from a cost benefit report submitted to HHS).

In New Mexico, a Medicare HMO increased access to alternative medicine from 500 seniors in 1999 to over 21,000 seniors by 2007 using ABC codes (click here to read details from a cost benefit report submitted to HHS).

The American Nurses Association, representing 2.9 million nurses, included ABC codes as a “recognized” nursing terminology in 2000 and has encouraged adoption of ABC codes since that time (click here to read the ANA's letter to HHS).

Dubai Healthcare City (DHCC) is using ABC codes to process complementary and alternative medicine (CAM) claims.

ZipClaims.com, an online electronic claim filing system, is successfully generated thousands of paper electronic insurance claims from 35 non-physician practitioners since May of 2008. The system uses ABC codes to document and justify charges and then maps this information to the medical codes the government requires for electronic billing.

To learn more about ABC codes, please click here.

To learn more about the prototype electronic claim filing system that uses ABC codes to document care from non-physician practitioners, please visit ZipClaims.com.