Coding ‘destroys everything’: Former Mercy Health CEO on where healthcare reform should start

Nick Thomas (Twitter) – Thursday, June 29th, 2023

Michael Connelly is the former CEO of Cincinnati-based Mercy Health, serving in that role between 1995 and 2017. The author of “The Journey’s End,” which highlights his frustration with billing issues at the end of life, Mr. Connelly spoke with Becker’s about such frustrations and recommended possible solutions to billing and coding as a whole.

Question: What is the biggest problem in healthcare right now?

Michael Connelly: Coding. If you track it down, it destroys everything, it’s insidious and has corrupted the medical record system. It also encourages fraud. Complexity is the ultimate inviter of fraud. Coding executives make more money than doctors themselves.

Q: How does revenue cycle management play a role in this?

MC: Ten years ago, we didn’t have RCM. Now, it’s a $140 billion industry, bigger than the entire U.S. auto industry at $101 billion. These massive expenses add nothing to patient care, and in fact, caregivers are leaving healthcare because of the massive headache medical coding causes.

Q: How does coding affect doctors on the front line?

MC: Doctors spend about 46 percent of their time on this. Physicians actually lose income by talking to patients as that’s not subject to coding.

Q: Why is the phrase “medical necessity” so manipulative?

MC: Insurance companies use that term to unfairly deny needed patient care. We have made the system more and more complex; there are more than 180,000 codes now.

Q: What’s the fix?

MC: Reforming healthcare desperately needs simplicity as its primary focus. Secondly, the payment model needs to be singular for all the payers. We cannot have each insurer creating unique requirements for the payment formula.