William (and group) I certainly do not want our group to "exclude" anyone's business needs. I agree with other commentors that CHs and VANS will not only be major players for the foreseeable future, but given the nearly non-existent EDI capability of small providers, our CHs and VANs would seem to represent the only way we will even get HIPAA airborne.
NEVERTHELESS... HIPAA is a regulation primarily about providers exchanging information with payors. HIPAA addresses the middleman facilitators because they are THERE. Few doctors and insurance companies, however, really want to be in the "EDI business"... most payors and providers appear to want to offload this headache to an AGENT and/or Special Software. Until CPA negotiation and EDI become trivial/transparent, we are going to need a robust layer of "EDI facilitator" businesses to make it all work. Twenty years from now, we will still see massive doctor disinterest in how this "EDI crap" works! Once solid standards are implemented, it's reasonable to expect the big, sophisticated communicators (payors... with actual IT departments) to begin managing their own EDI. Doctors, however, will (we hope) still be primarily interested in medicine... and will always need massive support for B-B communication. The way I see it... far from being on the verge of extinction, the "middleman" industry is likely to swell up over the next decade and SWALLOW up the IT needs of every little player in health care... even providers' "internal" IT needs. This discussion has shown that many communication and addressing models are in actual use today and some of them seem to conflict with "common sense" when applied to a theoretical "point to point" direct-communication model... something that needs to be defined, but is generally individual providers conversing with individual health plans. I think we all can agree that the "CH" or "VAN" industry will be seriously MUTATED over the next 2 or 3 years, and that dozens of variants of the "middleman" business model are likely to emerge in healthcare... mainly around newly-acknowledged PROVIDER needs. So my suggestion to focus our committee's recommendations and proposals on the "point to point" model was intended to give us a clear, common target to fire our recommendations at. I agree that these recommendations should and likely will be useful to CHs and VANs in the near term... ditto for anything resembling a central player-ID and address registry. Once we have agreed on the definition of the COMMUNICATION MODEL that we want our recommendations to support, I believe we will get past this bottleneck and be able to get to work on the papers. Please be patient with this "rambling" discussion. We seem to be close to consensus, but you cannot make something this big "simple"... no matter how much we all wish that it were. I'm actually impressed with this group's patience and willingness to tolerate this useful [if protracted] dialog. Thanks, -Chris At 06:12 AM 4/15/02 -0400, William J. Kammerer wrote: >I see no need to explicitly focus our recommendations on direct >point-to-point to the exclusion of clearinghouses. The discussions to >date have talked about Delivery Channels within the CPP which are >somewhat capable of supporting clearinghouses. > >Actually, intermediaries - like VANs and CHs - will be able to use our >recommendations just fine. I can imagine a provider contracting with a >CH intermediary for all communications. Thus, the CH will benefit by >being able to discover where the provider's partners (payers, TPAs, >etc.) are automatically - and they certainly won't all be customers of >the CH itself. The provider in this case has delegated the task of >looking up and discovering CPPs to the CH - which itself is a valuable >service (that the CH can tout). > >But having said that, providers themselves who have contracted with >clearinghouses have no direct need for our recommendations. The >recommendations will be of most value for providers and payers (and CHs, >TPAs, billers and repricers) who wish to connect to each other directly. > >William J. Kammerer >Novannet, LLC. >+1 (614) 487-0320 > >----- Original Message ----- >From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]> >To: "WEDI ID & Routing" <[EMAIL PROTECTED]> >Sent: Friday, 12 April, 2002 05:34 PM >Subject: Re: FW: A proposed work plan for this group > > >I would like to make a motion that our proposals be designed >specifically to meet the business needs of INDIVIDUAL PROVIDERS wishing >to directly communicate with INDIVIDUAL PAYORS. > >My reasoning: Some of our inability to reach clear consensus appears to >be fuzziness about the intended target audience for our address >discovery schemes and any "best practices" recommendations, such as who >the "ISA receiver" should be, bundling transactions destined for >different receivers, etc. If our work products are well suited to 2-way >communication between "little providers" and "big payors", however, they >may also be of interest to middleman entities like VANs and CHs who are >interested in creating services for doctors. Given the variety of >current business practices among existing middleman-players, however, I >think it would be a mistake for this group to attempt to "support" in >our recommendations what these guys are doing today . > >If we limit our scope as suggested, we will be writing specifications to >support a business model that has not yet emerged in the marketplace: >lots of small providers sending/receiving directly with lots of >individual payors. In fact, massive "direct connect" EDI may never >emerge in healthcare IF the middleman industry does a terrific job of >packaging up simple, cost-effective solutions for offloading this >headache from the doctors. From the doctors' point of view, they have to >PAY SOMEONE to work this magic and they could give a rat's butt whether >it was a "VAN", a "CH", or a $20,000 software upgrade... just so Suzy >knows which button(s) to push and they eventually get paid! > >Comments? > >Regards, >Chris > >Christopher J. Feahr, OD >http://visiondatastandard.org >[EMAIL PROTECTED] >Cell/Pager: 707-529-2268 Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
