Deb Markowitz recently unveiled a plan for health care reform that leads with a proposal that raised serious concerns to me.

I will launch a pilot program statewide with the largest hospitals and doctors groups to implement standardized billing procedures that will reduce overhead in health care, cost consumers less and eliminate headaches for  medical professionals.

I’d like to make clear that I would support Deb if she wins the primary and think she would be huge improvement over the Douglas/Dubie approach. However, as an expert on this issue in my non-blogging life (I’ve been asked to testify to state legislators on this subject), I feel compelled to raise the issue while we are trying to chose the best democratic candidate in our primary election. The proposal brings into question the depth of knowledge of this critically important state issue.

The problem with this proposal is that there is already a national billing standard, and creating another “standard” would either be unenforceable, or worse, would actually add to the administrative burden if enforced.

I’ll try to outline the details of this issue below the fold without getting too wonky on technical billing issues…

On the campaign webpage, and just now as I am typing this in the VPR debate, Deb Markowitz is touting her plan to reform health care with a central goal of creating standardized billing procedures.

This proposal seems to be ignorant of the fact that there are already “standardized billing procedures” outlined in the Administrative Simplification sections of the 1996 HIPAA legislation. In fact, the current environment is much better than it was in 1996 when insurance companies could each dictate their own standards. Now we have a significant level of standardization across all payers, although ironically state medicaid systems like Vermont’s tend to be the least compliant among payers.

As I said, there are two damaging outcomes that could result from the Markowitz proposal.

First, if VT enacted its own “standards”, they would be in conflict with the national standards, and most insurers who do business in Vermont would simply not accept them and point to the national requirements as a defense. I don’t understand how anyone would make this proposal seriously and expect it to be carried out, if they understood the health care environment.

Without question, even if this was enforced on some payers, Medicare would continue to follow the existing federal standards that they are so integrally involved with. So the other possibility is that somehow VT obtains a waiver in our lifetime to create another “standard” and there is effective enforcement to force all participants other than Medicare to comply. All Vermont providers (and others doing some business in VT) would have to then create and support a parallel programming track to meet these specs when claims go to payers that follow the VT “standard”.

So rather than save money, the best this proposal could hope for would be to be ignored, otherwise it would actually ADD to the already mind-numbingly wasteful health care bureaucracy overhead.

This may seem a bit too technical to get all lathered up about, but it comes down to this – a candidate running for governor (and certainly a governor) needs to know the technical details of a vital issue like health care before they propose something that could be ineffective or counter-productive. I’ve shared this concern with the candidate and the concerns were not recognized, indeed this plan was mentioned again tonight. I hope that Deb will consider these concerns anew and engage in a discussion or explain her rationale further here on GMD.

We need a nominee who has the depth of understanding of vital issues to stand up to Brian Dubie and present a vision of competence and leadership for the general election, and to governing effectively after victory. I’m hoping that raising these concerns here will help us towards an end result of a nominee that possesses those qualities.