Love needs a billing code

It's the simplest of ideas in health innovation: Give love a billing code.

I tweeted this in the spring of 2008 at Health 2.0 Conference in Boston.  Since then these words have been echoed, referenced and morphed by many friends and even by some I've never met in the industry.   

Love needs a billing code brings the idea of care and healing back to simple.  It rallies good people working in this space, reminding us why we started in health care in the first place.  The expression is activating too. It makes explicit a core value "To Love" that most of us presume is already present as an under layer in health transactions.

Love is not an industry standard.  The presumption that love is integrated into most health care transactions is flawed.  I am tempted to be flip and to say that profit is the reliable standard at work in the industry. While there is good reason to utter such a phrase, I know my tired soul is talking and I don't want to give voice to broken things.  I continue to dream the possibility of a more loving system end to end. One that is as big for love as it is in love with big data.

There are moments of love in today's health centers, doctors’ offices, and hospitals.  We see miracles and extraordinary feats of humanity so great that we cry every time we encounter them.  But my experience is that our health care ecosystem is unloving and … quite frankly … unlovable.

So why is there not a billing code to measure the caring potency of a health care encounter? Why is this idea dismissed as silly, as lacking gravitas, or as poorly matched with western medicine? Is love considered a downstream transaction? First see the doctor and then find the love you’ll need to heal?

We have walked on the moon, created unmanned drones to hit micro-targets far away, spent millions on challenges and prizes promoting health innovation, and yet we turn away from measuring the impact of love on the doctor and the patient. Why? This is a crime of omission.

Pink paper with question handwritten in black ink
  My question since 2008
Many consumers unconsciously approach medicine as if it were God's work.  Imagine what might happen if the industry - including insurance - actually caught up with us and started thinking of itself as doing God's work?  Not God 1.0’s work, but God 2.0, the caring, concerned, tech savvy and adaptive God who functions like a safety net?

What would happen when love met medicine? Would it lead to nefarious intent and abuse of power? Or would it perhaps be instrumental in creating a shift in consciousness? A shift inviting us to learn how to tolerate the unbearable losses and unexplained graces life, death and medicine bring into our lives. 

What if love had a billing code?


  1. Christine,

    Beautifully written and ideated. We should play it out - if love was a part of health care, does anyone think it would become (a) more costly (b) less effective (c) less timely?

    I was shadowing a physician yesterday whose family came to see him in the middle of the morning because one of his children was being seen for a well visit in another part of the building, and he said to us something to the effect of "really, we do work hard here" as he hugged his children and the other doctors and nurses came out to say hello. We just stood there admiring the scene and said, "this is the work." Who wants to put a stop to that? No one,


    1. Game on, Ted.

      Out of the box ideas like Love Needs a Billing Code rarely get a second look because they challenge so many assumptions at the core, turning upside down the conventional conversation of incremental improvements. In other words, "How much does it cost?", "What are the risks?" and "How can this be integrated into existing workflows?" uttered too soon these roadblocks shut down the thinking that may light a path out of another decade of paperwork re-engineering.

      Do you want to organize a group of folks across the spectrum of health and ask them how we can get traction? There is so much talent to tap at future-focused industry leads, .govs, e-patient groups.

      To quote, Susannah Fox, "What if?"

  2. Wow, you were at Health 2.0 in 2008? That's the first place Danny and I gave our speech.

    To answer both Ted and you, my view:

    1. Things only need a billing code in a fee-for-service world.

    2. I suspect that as providing care becomes more of a competitive marketplace, with better consumer mobility and better information about which providers feel great to work with, *the experience of feeling cared for* will be a biggie, and love & compassion will flow naturally.

    As we just discussed on Twitter, in 2011 Paul Levy's blog raised this again in Should there be a billing code for compassion?, citing his own PCP, Dr. Amy Ship, who brought this up 13 months earlier in her acceptance speech for the Schwartz Center's award for compassionate care. The speech is on his blog here.

    Seems this idea has been out there a while - time to do it - death to FFS. :-)

  3. 1. Agree, but am sorry the extent to which the fee-for-service model has its talons in;

    2. So many "ifs and whens" bundled within this statement; what can we do today? Can we give something away for free that gives people an authentic feeling of being cared for?;

    3. The phrase "the experience of being cared" for is a wonderful turn of phrase, Dave. Love that.

    1. I'm pretty sure I'm not the first to say "the *experience* of being cared for" - I picked up the idea somewhere, I know ... maybe I adapted it from a more general customer service principle: "Who gets to say whether the customer got good service? It all comes down to whether the customer FEELS LIKE they got good service."

      The very principle itself - service - involves being *of* service; subordinating one's own view to that of another.

    2. Coincidentally, @MarkHurst at Creative Good blogged on something very close to this topic yesterday. He approached the topic from the UX perspective, but acknowledges, "This 'genuine human interest' goes by different names, and it’s certainly not exclusive to the fields of customer experience and interaction design.

      His post: http://creativegood.com/blog/what-is-career-in-user-experience-really-about/


      BONUS: In his post Mark points us to a physics teacher's extraordinary personal story. That story illustrates "the force that is 'greater than energy… greater than entropy.'

      A must see that brings the conversation full circle, heart-shaped.

  4. Thank you Christine for this inspired and inspiring challenge to seek "a more loving system end to end, one that is as big for love as it is in love with big data." As a patient, I heartily applaud this. But as a realist, I can already imagine the eye-rolling among many physicians in response to it.

    For example, I've been following (and cheering!) the work of Dr. Victor Montori and his Mayo Clinic team who are working on the concept of Minimally Disruptive Medicine - an approach that examines the "burden of treatment", or how the "work" of being a patient can often exceed capacity to cope. It's a concept that asks docs to look at the whole patient, not just the 10 o'clock appointment.

    Yet even as Montori et al try hard to spread the wisdom of such compassionate assessment, at the same time we're reading shocking stats from the Center for Advancing Health that 91% of hospital patients are being sent home with NO discharge plan. Where is the love in that reality?

    We're reading in theheart.org that one of the reasons that a shockingly low percentage of heart patients are being referred to cardiac rehabilitation is that "doctors are in the business of prescribing drugs, not prescribing exercise" - despite the known longterm health outcomes associated with rehab. Where is the love in that reality?

    As much as I'd like to see a billing code for love, even more important to me is convincing doctors to show true caring and concern about their patients by following the treatment protocols that already have billing codes.

    1. Carolyn, thank you for your thoughtful post. The work of Montori sounds truly amazing, but the stat that so many are still discharged without an appropriate plan truly demoralizing. The space is riddled with such dualities.

      Eye rollers aside, at a certain point it must become simpler to get a helping hand.

  5. Here's a sneak preview of something the general public doesn't know about -

    Next month I'm doing my first management workshop, with one department at St. Luke's Hospital in Boise. In preparation they shared the moving and inspiring video in this blog post by their CEO, David Pate - a talk at their annual staff meeting with Cy Burr, a patient who was dying (died a couple months later), about the many dimensions of feeling taken care of.

    I'm working with them on implementing truly patient centered care, starting with what that means.

    A challenging aspect of this issue for many people, I've found, is that the higher you go in medical training, the more it's about technical information and skills (important, of course!) with less emphasis on care. Care, care, care. Who cares? Take care.

    One challenge is that sometimes the best way to care for someone is to NOT do services for them. In a satisfaction-driven world that works out fine; in Fee For Service, it's a fail. FFS is a great Satan in the context of care.

    1. Dave, your observation about "the higher you go in medical training..." sparked two thoughts (not original to me - quoting others):
      - pediatricians and nurses are the most likely groups to adapt their practices for continual quality improvement (said at a QI symposium I attended)
      - Patch Adams, MD, expresses the need for love and "feeling taken care of" in his 2010 speech at the Mayo Clinic's Transform event: http://www.youtube.com/watch?v=CdCrPBqQALc

  6. Just found your great post! We like your question, "So why is there not a billing code to measure the caring potency of a health care encounter?" Caring, respect, ethical practice, and other values are essential to compassionate, safe healthcare.

    Several years ago, we established an international collaborative effort to identify and promote the human dimensions of care.
    We’re working to enhance relationships and healing in healthcare, and created the International Charter for Human Values in Healthcare, starting with the capacity for compassion. The mission of the International Charter for Human Values in Healthcare is to restore the human dimensions of care – the universal core values that should be present in every healthcare interaction – to healthcare around the world.

    We invite you to join us in our work! http://charterforhealthcarevalues.org

  7. Very interesting work and thank you for posting your comment. As I read over the Charter, I was amazed that by even reading about compassion can introduce comfort and healing. I encourage others to read the Charter.

    One more thing stood out, it was this specific passage from your About page. This passage touched me because it speaks right to the center of health care's major duality: the conflict between that which we long to be present and that which is increasingly absent in the act of delivering or receiving care. It's as though we're losing a native language or a deep cultural tradition...

    The passage (with a minor edit in brackets to add emphasis) below:

    "Despite increasing awareness and hundreds of studies showing the importance of good communication and relationships in healthcare, compassion, caring and healing have diminished. [Yet] As we worked together from our diverse cultures, languages, backgrounds and perspectives to discover why healthcare is losing its human dimensions, we found that medical communities across the world share core human values. We recognized these values, the human dimensions of care, as primary. We developed an ongoing process to define and share these values."

    I hope the International Charter for Human Values in Healthcare will spread. Keep us posted.

    The International Charter for Human Values in Healthcare: http://charterforhealthcarevalues.org

  8. Check out Doug Neill's lively sketchnote for Love needs a billing code. Imagine if he captured all the comments too... Cool talent.

  9. Thanks for the thorough and well-written perspective on billing codes Christine.

  10. Christine, I love this post, and agree with your "diagnosis" but think you don;t go far enough in your "treatment". I completely agree that while many individuals in healthcare show love in their work, the system is toxic to this. At root is the fee for service billing system itself, which turns health care into a series of transactions. The solution isnt to create a billing code for love, but to take away the transactions completely and rebuild the system on relationships. We've been doing this at Iora Health for several years now (www.iorahealth.com) with great results. Thanks again for the post.

  11. Rushika, thank you for reading and posting. Your company is exciting; you've raised the bar and I love what you and your team are doing! I have many questions and curiosities regarding how business model transformation helps unleash the social capital we agree is blocked systemically. I hope we'll connect in DC or Boston to continue the conversation.

    Love is a word that sounds careless and conflicted to so many working in a system that values complexity, intervention, precision above all else. The idea of a coach or coaching is more aligned with norms while still promoting radical culture change... A good coach knows that providing space for a patient to experience what hurts before being hurried to heal is compassionate. I like that you are working with coaches so much! Whatever term we use, I agree that it is relationships that matter, this idea that one changes and grows and heals through relationship over time and across the life stages... This is life; the potential for health even in the face of disease.

    Can't wait to learn more about your team and plans for expanding your reach!
    I have not stopped investigating and meditating on the topic since writing this post in 2013. You are creating as close a platform to love as is possible in a market-driven system. I hope IORA is wildly successful.

  12. For those who don't know, Rushika is one of the most long-lasting, persistent creators of heart-and-soul driven innovative approaches to primary care. More than a decade ago he was spotted by "Doc Tom" Ferguson, founder of the e-patient movement, and was included in the manifesto he was writing at the time of his unexpected death. This January I wrote about his current company Iora Health on the e-patient blog.

    Check out what Iora says about its model:

    "Our care team, which includes a dedicated advocate for each patient, works together to treat the whole person. We see people when they’re sick, but also when they’re well, so that we can keep them healthy."

    Do click the link for that January post, and when you get there, read the e-patient white paper that it links to, where Doc Tom talked about Rushika's earlier work a decade ago.

    1. Thank you, Dave! We can always count on your thoughtful analysis.

      I apologize that this reply is so late. I posted back on the same day, but somehow it never made it here. Your comments are always rich with good thoughts and connections.