Hacking Healthcare

Chapter 5. Herding Cats: Healthcare Management and Business Office Operations

Medical operations are often divided into administrative and clinical operations. Here we take a look at some of the key aspects of administrative activities, with an eye toward where, why, and how IT fits in. After reading this chapter, you should know where your software fits into the basic system architecture, and therefore be more likely to avoid an implementation plan that overpromises and underdelivers.

Nearly all healthcare settings have a front office that has a medical director and handles all clinical aspects of the work, and a back office under a business manager that does administration, billing, and other business functions. This has proven to be a very unfortunate division, bringing to mind a Solomonic “solution” without the happy ending. In today’s world, the cost and profitability of both facilities and payers have an enormous influence on care, so the inefficiency created by the front office/back office division holds back creative efficiencies and adds significantly to the total cost for everything.

Perhaps in some earlier period there was a well-intentioned purpose to this division, such as to prevent cost and profitability concerns from having an undue impact on care. But the universal division of responsibilities is now a barrier. For instance, these two divisions often use two different software solutions provided by two different vendors, integrated by a third vendor. And meaningful ...