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The Business of Medical Coding: Part 2 of 4 "United States of Healthcare"

Posted by Stephanie Cecchini on Aug 27, 2015 4:30:00 AM

This is part 2 of a 4 part series on the business of medical coding.


The United States leads the world in medical innovation. We have the best access to the latest medical advances–largely because they were discovered, developed and produced here in the United States. We have access to diagnostics that allow us to detect health issues early. We have medical devices that unblock arteries, replace joints and even body parts. We have medicines that have significantly lowered death and disability rates from heart disease, cancers, stroke, and other diseases. We have made HIV a treatable, chronic condition.


This might be news to rejoice if the high cost was producing a sustainable supply and demand, wage increases, or lower unemployment…or even just a longer average life expectancy for U.S. citizens. Despite being one of the best—and the costliest system in the world, it has done none of these.


The unfashionable truth regarding healthcare business in the United States is that, like all businesses, the goal is to make money. Lots of it. Our healthcare spending grew 3.6 percent in 2013, reaching $2.9 trillion or $9,255 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for 17.4 percent. In terms of the average working person—this is about $3,500 per year….or 5% of an individual’s before tax income, more if you calculate Medicare and Social Security tax.As one of our top economic industries, there is political interest in the costs. There is no final agreement on how to cut costs. The debate has swung from the right-wing ideal of a free-market driven private care system, to the far left of a single payer system.

The political deliberation has resulted in a compromise that has been a government-based system for some (Military, Veteran, Medicare and Medicaid) and a private but heavily regulated system for everyone else. Although there has been no shortage of discussion on the politics of healthcare, surprisingly few Americans are aware of the large number of people and businesses concerned with the topic.


Physicians are a very small part of a large network of interested stakeholders. The Bureau of Labor Statistics shows 11,756,610 healthcare workers, and only 6% are physicians. This total number of workers doesn’t include ancillary workers such as schools, associations, law firms, and other interested parties—making physicians a very small aspect of the total network.


Current efforts in healthcare reform have come from the American Recovery and Reinvestment (ARRA) Act of 2009 and the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), which sought to fix three problems: coverage, cost, and quality of care.


To extend coverage, the Affordable Care Act made it compulsory for Americans to have health insurance or else to pay a fine. It offered subsidies for those it defined could not afford it, and prevented insurance firms from charging people more for pre-existing conditions.


Costs and quality of care were addressed by simultaneously shifting the financial burden between the taxpayer, patient, and provider. Proponents of the law believe that healthcare will become cheaper in the future because many of the law’s new rules are meant to improve the health of our population and as a result, reduce costs. Compelling cost savings have not yet been demonstrated.


Interesting Facts:

  • 974 pages in the Affordable Care Act of 2010
  • 407 pages in the ARRA of 2009
  • 45 pages in the Constitution of the United States of America & Amendments (literal print)



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About Stephanie Cecchini: 

Stephanie is the Vice President of Medical coding services at Aviacode. Executive level revenue cycle management consultant. Stephanie has a notable variety of experience within the healthcare IT industry. CPC, CEMC, CHISP AHIMA Approved ICD-10 Trainer.


Topics: Medical Coding, United States Healthcare