Saving Healthcare: How to Make Rural Healthcare Viable

Make the small/rural hospital lean and mean and steal patients from the big insurers and hospital systems

Introduction

Today we are going to discuss the problems associated with rural healthcare and the solutions we have identified.  We will look at why rural healthcare is in trouble, what happens if it collapses, and what the real solution is and what it takes to implement that real solution

The Situation

• Between 2017 and 2024, 62 rural hospitals closed their doors for the last time, out of about 1800 nationwide.  This is an indication of the problems facing all small and rural hospitals in the US currently.  
• Rural hospitals subsidize big systems by being forced to accept lower payments while urban facilities leverage-negotiate higher rates.
• 1 in 5 rural Americans lives 30+ min from emergency care
• Legacy model: go to the hospital when the pain becomes unbearable or things don’t work and then to the ER, mostly because of expense
• 90% of US healthcare spending is on behavior-based, avoidable chronic disease.  This is due to non-engagement of the patient in participating in their own health at least with diet and exercise.
• Legacy insurance: you only get ~35% of premiums back as benefits 
• Low engagement due to excessive cost, as outlined above.

Legacy systems are structurally incapable of delivering value in medical care.

The Logical Conclusion

The current thinking on healthcare finance models is that they are the anti-solution and can’t be fixed by tweaking, more point solutions, financial and accounting legerdemain or government intervention.

That means that the collapse of rural healthcare is imminent.  People are going to die. This is due to the outdated thinking on finance, the insurance focus on paying for procedures instead of steering for positive outcomes, the negotiating power of the big systems soaking up payments to small hospitals. chronic disease, insurance inefficiency/denials/delays/process, and lack of engagement in the population

The Short Answer

Money fixes everything. Replace the anti-solution with a suite of modern systems that streamlines and automates processes, including replacing insurance entirely.  Provide the hospital with a DVS based EMR.  Provide the hospital with integrated coverage, entirely replacing the legacy payers and all the additional work they require, and all the costs associated with that additional work.  Provide the hospital with a management system that actually tracks and controls costs and tracks and controls the labor necessary to accomplish all the tasks.  Provide the patient with a health and wellness system that keeps them healthy and out of the hospital, freeing practitioners to work on acute care instead of entirely avoidable chronic care.

The Slightly Longer Answer

Electronic Medical Records (EMR) built on a Discrete Value System (DVS)

While this sounds like a non sequitur; who really cares about documenting care in a system that will fail?  The EMR is the sine qua non of the solution’s suite of applications.  Sentia replaces free-text notes with UMLS-based discrete values.  This one change drives the value in value-based care.  For the first time we can associate symptoms to observations to lab results to diagnoses to ultimate outcomes.  Sentia’s Discrete Value Based (DVS) based EMR is the only one of its kind.  

Integrated Coverage + Real-Time Payment

Coverage goes right in the Sentia EMR.  As soon as the practitioner clicks save, the payment for services provided get started.  This eliminates the insurance monkey motion of claims and denials and pre-auth and everything else they do or require that consumes over 65% of any premium they are paid.  With reference-based pricing Sentia eliminates networks and negotiations as well, the little hospitals get the same payment as the big ones for the same procedure.

Integrated Health and Wellness

Avoidable, behavior-based, chronic disease consumes about 90% of all healthcare spending in the US. the OECD average mortality for these diseases is 225 per 100,000.  In the US it is 336 per 100,000, or about ⅓ lower internationally.  Sentia provides an integrated health and wellness package that prescribes customized patient education based on lab results and clinical measurements.  When the patient follows the education and lab results improve, they are paid with a 15% discount on coverage.

ERP Hospital/Practice Management

This allows us to track every bandage, every hour, and cost.  Along with the DVS based EMR, we can produce a Profit and Loss (P&L) statement for every employee, procedure, room, piece of equipment, consumable, floor, wing or any combination of those, making cash leaks easy to fine and not require an army of accountants and spreadsheets.

Hospitals and practices always complain about workflow disruptions.  In reality, workflow is the cause of these disruptions.  Imagine a ward with 20 rooms and one nurse for every four rooms.  One nurse is “in the weeds” with more to be done than can get done. One is right sized and the other three are sitting around “charting.”  One or both of the bush nurses are forgetting about and missing tasks and process, the other three are increasing costs for everyone by consuming valuable resources and providing no care.  A better way is to have an automated queueing system that assigns the oldest or most urgent task to the longest idle nurse, ensuring that everything gets done with the right amount of labor.  

This also gives us the ability to produce efficacy reports or to find out which nurses are the most effective with data, and not a popularity contest.

Conclusions

Let’s put some numbers to the savings and then discuss why this all matters, and how it solves the problems.

• 65% savings from coverage integration
• 25% savings from health and wellness program
• 25% (of hospital costs) savings from PHM
• 25% (of administrative costs) integration tax elimination

We have shown a complete system to dramatically cut the cost of healthcare in the US.

We have shown a way to regulate every financial transaction a practice or a hospital enters into, the Practice/Hospital Management System (PHM). Included with the PHM is a workflow elimination tool that extracts more and better work from employees and streamlines and automates every facet of patient care. All that increases revenue and decreases costs by about a quarter.

We have shown a way to incentivize healthy living in a population and decrease chronic disease and therefore decrease costs for us all in a streamlined and automated manner. This alone has the potential to save $1.5 trillion or about 25% of healthcare spending in the US

We have shown a way to revolutionize the way medical records are thought of, executed, used and searched. This eliminates Epic, all the legacy EMR vendors and makes research a simple pick and click operation, saving millions of lives.

We have shown a way to integrate health coverage into the EMR. The practice or hospital gets paid as the practitioner documents patient care. That eliminates medical coding, verification, adjudication, pre-authorization, denials, delays, insurance networks, rate negotiations, sales/brokers/agents, money for a third-party EMR, skyscrapers in every major city, hundreds of thousands of employees, all the insurance monkey business and reduces cost by about 65%

It also eliminates Epic/Cerner AND the legacy insurers.

It also makes the medical facility leaner, faster, more efficient and more profitable.

All this allows the rural or small hospital to be leaner and more efficient in treating patients. It allows more profitability which in turn allows for more and better equipment and facilities and even new facilities.  It keeps patients healthier by incentivizing reading and following patient education, freeing staff for acute care instead of chronic care. It eliminates all the time, money and effort that goes into dealing with the legacy insurance company’s processes that don’t add to patient health at all. It accounts for all spending and all labor costs and controls them near automatically.

Deployment Options

We have to talk about the nuts and bolts of how this system works.  There are three deployment options, and one is particularly suited for the small or rural hospital. In all three the subscription fee is only $10 per month, plus the actual cost of the risk.  This is where almost half the cost of the saving comes from; eliminating insurance.

Sentia Health Coverage

Sentia can be the company that administers and pays for coverage.

Sentia Third Party Administrator (TPA)/Captive

Sentia can be the Third Party Administrator or captive company that coordinates and aggregates employee’s care and sends a bill to the employer at the end of the month.

Sentia as the Direct Universal Care Facilitator

Sentia can provide the software to your hospital or practice and allow you to provide your own coverage.

In all three cases, the charge is the same; a very Netflix-like (at least used to be) $10 per month plus the actual cost of the risk.  The link explains exactly how we calculate risk and we also publish exactly what the risk is per procedure on our site and in the EMR itself, so you and your doctor can discuss charges at the time of procedure scheduling.  This is all in the interests of transparency.  

Here are additional points detailing the costs incurred by the legacy insurance companies that you pay currently, in addition to wasting about 2/3 of your premium, according to Grand View Research and current as of 2023 and that Sentia would eliminate completely:

Medical Records:

• The average practitioner spends $35,925 annually on electronic medical records
• The average patient spends $106 annually on electronic medical records
• The average patient encounter or visit cost for electronic medical records alone is $32

Medical Coding:

• The average practitioner spends $20,286 annually on medical coding
• The average patient spends $60 annually on medical coding
• The average patient encounter or visit cost for medical coding alone is $18

Compliance and Efficacy Reporting:

• The average practitioner spends $17,165 annually on compliance and efficacy reporting
• The average patient spends $51 annually on compliance and efficacy reporting
• The average patient encounter or visit cost for compliance and efficacy reporting alone is $15

Totals:

• The average practitioner spends $73,376 annually on completely avoidable costs
• The average patient spends $217 annually on completely avoidable costs
• The average patient encounter or visit cost for completely avoidable costs alone is $66

Yes, you read that correctly: $66 per visit. That is more than the practice makes on the average encounter. There must be a better way. There is a better way and Sentia has it.

Remember also that these costs are over and above the 65% your insurance company wastes or shoves into their pockets.

We have designed and are building an ERP style practice/hospital management system that will pinpoint and eliminate cash leaks and inefficiencies in enterprise medical facilities. Implementing this system should be fairly simple and will completely revolutionize the way healthcare is delivered and paid for, saving countless lives. We have shown a way to use this system to make the best healthcare system in the world also the most efficacious and the most affordable.

If you liked what you read contact us here, on our site, SentiaHealth.com, our parent company SentiaSystems.com, or send us an email to info@sentiasystems.com or info@sentiahealth.com.