P & L not spoken here

Knowing a little bit about healthcare is a dangerous thing as healthcare operates differently from any other business in the world because billing is separate from services rendered, thus insuring built in complexification enabling insurance companies to generate enormous profits from an industry no one seems to understand.

Back in the day, there was one unified document underlying the care of patients with the first part dealing with medical, known as the note. The second part, dealing with financial, is the claim. Originally said document, the note/claim entity, was a single file until the insurance companies split it in two, thus, as stated before, separating payment from services rendered, which guarantees insurance company hegemony over compensation given to doctors and hospitals as needs warrant. No other industry works this way.

If one goes to Starbucks to buy a cup of coffee, you, the purchaser, generates a PO in the guise of a check, cash or credit card to buy the cup of coffee. When Starbucks receives the PO, it instantly becomes an invoice, an instrument of gross income before expenses are placed against what the customer pays for the cup of coffee including payment to the barista, the wholesale cost of cup and coffee plus the cost of maintaining the space required to enable Starbucks to do business. By having payment directly connected to services rendered, a true Profit & Loss environment can be established, just like every other business known to man. 

With HC, a true P&L business model cannot be established because the artificial split between the note and claim eliminates the possibility to automatically track the inherent cost of doing business as it unfolds, To see why, the diagram below beckons.

Siloed data, similar to the Pentagon's, insures the grim reality HC will never work in this country with any degree of efficiency unless billing is directly connected to services rendered, something akin to universal HC where the insurance companies are eliminated from the equation to enable HC to be run like any other business in the world. 'Nuff said.