Once upon a time, if you wanted a cup of coffee in the office, you just went to the coffee urn and poured yourself a cup.


To research this column, I just visited our office kitchen. I counted the following items that can be used in our coffee machine: six types of coffee, two types of tea, hot chocolate, and two types of cream.

And at a diner, once upon a time, you just ordered coffee. If you lived in New York, you ordered “a regular,” which was coffee with cream and sugar. And there were a limited number of ingredients you could add in a limited number of ways. You might order a “light” or add a couple of packets of sugar.

Now, of course, ordering a half-decaf, extra hot, skinny mocha latte at the local coffee shop has become commonplace.

On one hand, this additional complexity is appealing. We all get exactly what we want, no matter how idiosyncratic. Yet complexity can also be a barrier. These days, I drink water rather than navigate our company’s coffee system. (Well, to be honest, I also prefer water.)

Health care is notoriously complex. In the January 2013 hfm article “Addressing Healthcare Complexity,” authors William B. Weeks and Eric B. Wadsworth pointed out that health care does not have a defined set of “ingredients,” that each patient’s characteristics are “unique, uncontrollable, and not entirely predictable.” The authors also pointed out the financial complexities of health care that you are all too familiar with, such as that an out-of-pocket cost might be the same for “an unnecessary MRI as for a life-saving heart bypass operation.”

And some areas of health care are more complex than others. In this month’s issue, the authors of “Improving Pharmacy Revenue Integrity” present a case study from Billings Clinic in which staff reduced fluctuations in medication charges, aligned charges between the organization’s hospital and clinics, and created an ongoing potential to enhance revenue integrity and patient satisfaction. According to the authors, improving revenue integrity is never easy, but it is especially difficult in the pharmacy:

The complexity of pharmacy revenue cycle operations makes it difficult for healthcare organizations to identify disconnects between the amount of medication purchased and dispensed, the amount charged for particular subsets of drugs, and the payment received.

The authors emphasize that the complex nature of the pharmacy is a barrier worth overcoming because of the millions of dollars in revenue that could be lost from billing system deficiencies or missing data. After you read the process that the Billings Clinic went through, the improvement process will look far less daunting. 

Everyone who toils in healthcare finance has made a commitment to confront complexity every day in service of the public good. And on most days, that’s a lot more satisfying than even the best grande whole-milk latte with an extra shot.

Publication Date: Sunday, September 01, 2013

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