The Gurley Rule of Bureaucracy: The complexity of a bureaucracy is inversely proportionate to the clarity of the idea behind it.

Following on from the first post about Medical Homes and the bureaucracy that was involved in creating and driving the concept, here are some thoughts on medical bureacracy.

Good Bureaucracy: If you’re in health care and you amputate the wrong limb, that is bad.

1) While not as simple to avoid as initially believed, there are achievable preventative steps to help ensure better outcomes.

2) It is unambiguous when such a tragedy has happened.

Illustration for the topic of bureacracy. The ...

Illustration for the topic of bureacracy. The form is fictional. (Photo credit: Wikipedia)

3) If you do this to someone, you will be punished for it, and…

4) if you haven’t been doing those preventative steps when it happens, you’ll be punished even more. That is a level of bureaucracy I really support.

Bad Bureacracy: The flip side of health care bureaucracy proliferation includes:

1) The boom and bust years of Diagnosis Related Groups: the hubris of thinking that all diagnoses – such as all diabetics – should just be paid one lump sum for all their care, no matter how sick or complex the person’s illness.

2) All of ICD-9: the hubris of thinking that every disease in human experience can be numbered, even before you have a diagnosis, and used as the basis for payment of a doctor’s time.

3) The tsunami of ICD-10: Since ICD9 has become a disastrous bureaucratic nightmare, the Center for Medicare and Medicaid Services (CMS) decided to … massively expand it (150,000 codes!). ICD10 will not only require changing every single current health-technology tool right after they were implemented, but will also give us such gems as specific codes for “struck by a turtle” (W5922XA) and “burn due to water skis on fire, initial encounter” (V91.07XA, see more here).

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