RT Welter and Associates is thrilled to announce that our own R. Todd Welter recently revisited Beijing, China to work directly with healthcare professionals in providing insight to the American Healthcare System.
CEO of RT Welter and Associates, R. Todd Welter went to visit 5 hospitals in 5 days in a whirlwind trip to Beijing, China (now a city of over 20 million people) to provide area medical professionals with insight to how the American Healthcare System works. Welter spoke on topics of medical coding and revenue cycles… and a bit about American politics.
Welter visited China back in 2004 for a similar trip, and the hospital associates there were anxious to meet with the American medical billing and healthcare expert again. For insight into his trip, and a review of the 2004 venture, check out an article by Welter, below.
Third-Party Payer Committee
By Todd Welter
Billing and Coding, Medical Records and Managing Healthcare
I am in Beijing China, a city of over 10 million. I was invited by a Swiss company to attend The Chinese Orthopedic Association’s National Congress. Over 2,500 Chinese physicians will attend to hear discussions on the latest surgical procedures, new products, and new ideas on patient care. I have traveled with my friend Dr. Michael Janssen, an internationally known and well-respected orthopedic spine surgeon. Dr. Janssen has an orthopedic spine surgery practice in Thornton, Colorado.
In addition to our official duties, the obvious tourist opportunities, and the many complex social events we are invited to, I am determined to learn as much as I can about the Chinese healthcare system, how it is financed, how records are kept, and how the physicians are compensated (who said healthcare business consulting is boring?)
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The Chinese system for coding is not as specific as ours. Even though they perform essentially the same services and procedures, they record very basic, general service descriptions. They then have a fixed fee schedule for all services. The patient pays for medical care, many times in advance. If it is not paid for, it is simply not done.
The Chinese people, those living in the larger cities at least, have insurance. In China, employers pay for the insurance. Most of the time the insurance pays very minimally and the remainder is paid by the patient or their family or outright by their employer.
I am visiting the Beijing General Military Hospital, a sprawling 1,100 bed facility in the heart of Beijing, a few minutes from Tiananmen Square. Our hosts tell me that this is the best hospital in all of Beijing. I find the facility to be very “1950’s Institutional.” Stark white tiled walls and floors. No patient amenities (televisions, bathrooms in the rooms, etc.). Other than that, the set up is very similar with one very notable exception. In China, the patient’s family is expected to play a big part in the patient’s care. The patient’s family does a lot of what we call nursing care (food, patient comfort, even moderate physical therapy). Every patient room I saw had at least one extra bed in it for a family member.
I was very privileged to be able to discuss the Chinese systems of record keeping, coding, charges, and reimbursement with the hospital’s Vice President of Finance who is also a gastroenterologist. All the physicians at this hospital are employed by the hospital. Many have apartments on the grounds of the massive complex. Physicians are paid a salary and then receive bonus pay based on their productivity (number of cases, patients seen, etc.). Physicians are also able to receive additional compensation for a wide variety of other efforts, some officially frowned upon but openly accepted.
The hospital and physicians use a single electronic medical record. Computers throughout the facility are able to access a patient’s record, charges, physician notes, nursing notes, etc.
One area of great difference is the concept of outpatient surgery. The Chinese do not perform “outpatient surgery.” Part of our visit to the facility included a session with the Orthopedic Department to do case reviews. There was a kind of International Grand Rounds done with Dr. Janssen from Denver and a physician from Prague. The Chinese physicians discussed several cases and presented their x-ray results, including MRI. As it turns out, a procedure that could be done in Denver in 30 minutes with a 4-hour stay in an outpatient facility would result in at least a 2-day in-patient stay in China.
The Chinese system appeared to equal ours; in fact they perform the same complex procedures we perform (open heart surgery, complex spine and neurosurgery, transplants, etc.) in addition to all the more routine services. Their system was, however, remarkable for it being less efficient than ours. On the provider side, it appeared that their system is hospital-centered rather than physician-centered. They therefore, don’t seem to be as concerned about seeing as many patients as possible, turning around O.R. rooms quickly and getting the patients out of the hospital as soon as possible. I was struck by this difference.
Based on this trip, other international visits, and even many domestic observations, I am starting to conclude that the American system of healthcare, with all its apparent blemishes, owes its efficiency to American physicians playing such an important role in it. The concept of system efficiency is lost to the Chinese, because it is a hospital-centered system. The lesson in this may be to protect and, in fact, strengthen the physician’s role in healthcare rather than allow it to continually erode. It appears, by observation, that when there is a system which does not allow the physician to initiate care, make decisions, order, admit and discharge while compensating him/her to do so in a way that values this expertise, the system suffers from inefficiencies, lack of creativity, and thus higher costs.
Being a coder at heart, I brought a 2004 CPT book with me and showed it to them. Its level of detail mesmerized them. We agreed to exchange pricing information and I was allowed to photograph much of the facility including patient rooms, patients, and even a medical record. (Something we could never do here.) The company who invited me to China is sending me a large package of information on the Chinese healthcare system for follow-up.
The President of the Beijing General Military Hospital presented us gifts. He gave Dr. Janssen the title of Honorary Chairman of the Orthopedic Department (a very high honor) and presented me with a traditional Chinese tea set (something we will cherish at my home). I plan to send him a copy of John Fielder’s book of Colorado photographs and, of course, a CPT book.