Complexification 101 ...

Keith Corl, a critical care specialist who quit a lucrative job in finance to become a physician.
Credit...Balazs Gardi for The New York Times

HC in America is in crisis as it's all about the money yet again with doctors, nurses and patients being compromised thanks to the inherent corruption of the system nobody seems to understand, a situation purposely cultivated by the powers at be to keep everyone in the dark regarding an industry no one seems to understand.

HC operates differently than any other business in the world due to the fact billing is separate from services rendered, a notion the Apple's of the world would consider to be patently ridiculous from the get go as Apple can do P&L without question while major hospitals do guesstimates due to the fact the workflow's wrong thanks to the indirect way billing is connected to services rendered.

See chart below

Why is billing separate from services rendered? Well, in medical, procedures are always delineated before diagnosis, a patiently ludicrous concept as a doctor has to diagnose what's going on with a patient before recommending a procedure to help the patient in question. Why is this so? Because it's easier to split the note from the claim, thus gaming the system to make ever more profits, when the two are purposely reversed even though the doctor's note always drives the claim, (Note/Medical | Claim/financial), something HC providers purposely did years ago even though the note/claim entity has been a unified construct as seen in the fields used to define the dataset when the government pushed for the industry to go electronic back in the 1970's.  

The artificial split of the Note/Claim entity. Note/medical | Claim/financial
This split also renders the ability to do effective P&L impossible

The corporatization of health care has changed the practice of medicine, causing many physicians to feel alienated from their work.

Some years ago, a psychiatrist named Wendy Dean read an article about a physician who died by suicide. Such deaths were distressingly common, she discovered. The suicide rate among doctors appeared to be even higher than the rate among active military members, a notion that startled Dean, who was then working as an administrator at a U.S. Army medical research center in Maryland. Dean started asking the physicians she knew how they felt about their jobs, and many of them confided that they were struggling. Some complained that they didn’t have enough time to talk to their patients because they were too busy filling out electronic medical records. Others bemoaned having to fight with insurers about whether a person with a serious illness would be preapproved for medication. The doctors Dean surveyed were deeply committed to the medical profession. But many of them were frustrated and unhappy, she sensed, not because they were burned out from working too hard but because the health care system made it so difficult to care for their patients.

Truer words never spoken

In July 2018, Dean published an essay with Simon G. Talbot, a plastic and reconstructive surgeon, that argued that many physicians were suffering from a condition known as moral injury. Military psychiatrists use the term to describe an emotional wound sustained when, in the course of fulfilling their duties, soldiers witnessed or committed acts — raiding a home, killing a noncombatant — that transgressed their core values. Doctors on the front lines of America’s profit-driven health care system were also susceptible to such wounds, Dean and Talbot submitted, as the demands of administrators, hospital executives and insurers forced them to stray from the ethical principles that were supposed to govern their profession. The pull of these forces left many doctors anguished and distraught, caught between the Hippocratic oath and “the realities of making a profit from people at their sickest and most vulnerable.”

The system must change, NOW.