A Timely Fix for a Sick US Healthcare System?


By Melinna Giannini / Spillman

March 8, 2022

According to a February 6, 2022 episode of “60 Minutes”, front-line doctors and nurses are quitting practicing in record numbers due to the hardships they face dealing with the pandemic. As of September 2021, the Kaiser Institute wrote that the US had less than 50% of the primary care providers needed and, given the reported recent burn out rate, the lack of primary care providers has increased. Couple these problems with reports from the government that Medicare and Medicaid are headed towards insolvency and you can begin to understand why the US healthcare system is in critical condition.

To alleviate current and upcoming care shortages, we must find new ways for patients to get more care at less cost. Thankfully, there are over 2 million licensed health professionals able to fill care gaps and, most of them charge less than physicians. However, the industry lacks the tools needed for these providers to get paid without physician oversight to manage patient care.

Back In 1998, a New Mexico company identified this problem and began developing solutions. The system it created was tested in over two million electronic claims by Alaska Health and Human Services. The state was able to document savings of 50%. By 2008, the company had developed a systematic way to verify legal scope of practice as claims were adjudicated by tying billable interventions to state scope of practice rules. Those interested in learning more about how this system increases access to qualified care providers, email melinna.giannini@abccodes.com.

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