Over $700 billion is wasted on unnecessary medical care yearly. This Boston Globe op-ed gives some eye-opening examples of where to start trimming the fat:
# Wide variations in patterns of care – why, for instance, surgery for coronary artery bypass or hip replacement is performed more frequently in one area of the country than another. Potential savings: $600 billion a year.# Medical mistakes such as wrong-side surgery, medication errors, and preventable hospital-acquired infections. Potential savings: $52.2 billion a year.
# The overuse of hospital emergency departments for nonemergencies. Potential savings: $21.4 billion a year.
# The underuse of drugs and other therapies to manage chronic conditions such as high blood pressure, diabetes, and asthma, leading to acute conditions (asthma attacks, insulin shock) and hospitalization. Potential savings: $5.5 billion a year.
# The overuse of antibiotics for viral infections (ear infections, sore throats, and the common cold). Potential savings: $1.1 billion a year.
Many of these issues can be resolved by reforming how doctors are paid. Remove the incentives to do more, see more, and treat more. Reward for healthy outcomes and for providing primary care physician access which can preempt expensive emergency department visits.
Related posts:
- Primary care is a lousy term
- Getting rid of a cold without antibiotics
- Medicare ceases to pay for medical errors
- Sword swallowing and sore throats
- Bacterial infection and cancer
- Medicare is no longer paying for complications
- Defensive medicine becoming standard of care?
{ 3 comments }
Have you run across any research regarding excess costs due to inefficiencies in the system? For instance, I once had a patient stay in the hospital an extra 4 days because he didn’t have a pair of shoes to go home in. The only reason he left at all was because we all chipped in to buy him a pair!
Another area of waste is the CYA mentality; I’m sure hundreds of thousands of unnecessary CT scans are done every year just to prevent missing something very rare.
On paper, paying based on outcomes sounds great. I’m just not sure how that could be structured without adding more complexity to an already complex system. I’m not convinced that we need to abandon the fee for service model. A good compromise might be to review outcomes on an annual basis when fee schedule negotiations take place. A practice with good outcome and utilization ratios compared to peers gets a bigger increase to its fee schedule. Of course, this assumes that we’re also going to simultaneously tackle the factors that are causing defensive medicine, as well as realign the RVU system to place more value on primary care.
You get too crazy about outcomes and you screw over the docs in the inner city and rural areas where patient compliance is worse.
At some point, society is going to have to place some trust back into the doctor’s hands.
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