I put Middle Earth Journal in hiatus in May of 2008 and moved to Newshoggers.
I temporarily reopened Middle Earth Journal when Newshoggers shut it's doors but I was invited to Participate at The Moderate Voice so Middle Earth Journal is once again in hiatus.

Saturday, December 15, 2012

6 Biggest Drivers of Healthcare Waste

Here is a site with links aplenty...
And here is the Cliff Notes version:
  • Failures of care delivery. This category includes poor execution or lack of widespread adoption of best practices, such as effective preventive care practices or patient safety best practices. Delivery failures can result in patient injuries, worse clinical outcomes, and higher costs.
  • Failures of care coordination. These problems occur when patients experience care that is fragmented and disjointed--for example, when the care of patients transitioning from one care setting to another is poorly managed. These problems can include unnecessary hospital readmissions, avoidable complications, and declines in functional status, especially for the chronically ill.
  • Overtreatment. This category includes care that is rooted in outmoded habits, that is driven by providers' preferences rather than those of informed patients, that ignores scientific findings, or that is motivated by something other than provision of optimal care for a patient. Overall, the category of overtreatment added between $158 billion and $226 billion in wasteful spending in 2011, according to Berwick and Hackbarth.
  • Administrative complexity. This category of waste consists of excess spending that occurs because private health insurance companies, the government, or accreditation agencies create inefficient or flawed rules and overly bureaucratic procedures. For example, a lack of standardized forms and procedures can result in needlessly complex and time-consuming billing work for physicians and their staff.
  • Pricing failures. This type of waste occurs when the price of a service exceeds that found in a properly functioning market, which would be equal to the actual cost of production plus a reasonable profit. For example, Berwick and Hackbarth note that magnetic resonance imaging and computed tomography scans are several times more expensive in the United States than they are in other countries, attributing this to an absence of transparency and lack of competitive markets.
  • Fraud and abuse. In addition to fake medical bills and scams, this category includes the cost of additional inspections and regulations to catch wrongdoing. Berwick and Hackbarth estimate that fraud and abuse added $82 billion to $272 billion to US health care spending in 2011.
     The footprint of most health care systems in America is often as big as an industrial park. There are so many clinics, labs, private practices, specialty centers, agencies, imaging centers, retail outlets selling durable equipment and disposables, pharmacies, the list is endless... And that doesn't take in to account the ancillary non-medical businesses from window-cleaning, landscaping and waste removal to uniform sales, food service outlets and parking garages. It takes your breath away to think of it. And every dollar supporting this is in one way or another the cost of health care in America. This is madness. Totally crazy. Insanely inefficient.
     The footprint of healthcare systems should be not much bigger than that of a good-sized hospital. And they should be scattered far and wide, like grocery stores, in proximity to the places where health care is needed -- NOT in the most affluent parts of the metroplexes where they are now concentrated. A more robust system of community health centers will be part of that picture. And that, too, is part of the vision of ACA.
     We are on the cusp of a healthcare revolution. And if those who cannot see the future don't succeed in killing it (and that's a big IF) , the US can and will become a model of excellence for the rest of the world that it should already be. I don't expect to see it in my lifetime. But my vision of what it can be in the future is very positive. (But no, it will not be a spontaneous product of free enterprise. That has proved to be a spectacularly expensive, inequitable and unsustainable luxury. See "footprints" above.)
Another contributing factor to costs which I have never seen mentioned anywhere in the literature is the misuse and accounting fraud of the term "non-profit."
Following the healthcare debate for several years, working in a hospital system for five years and spending the last four-plus years of my post-retirement life as a non-medical senior care worker has led me to the conclusion that most so-called not-for-profit operations are little more than money-laundering accounting gimmicks serving as hosts of FOR-profit operations. 
This argument underscores the point.
....nonprofit healthcare organizations defend their executive pay packages as essential to attracting and retaining top talent.
    And despite the controversy, executive compensation plays a minimal role in escalating healthcare costs, Sean Flaherty, a professor of economics at Pennsylvania's Franklin & Marshall College, told Lancaster Online.
     Similarly, compensation committee member Don Harting at Ohio's Kettering Health Network said, "I would also like you to recognize that executive compensation in the big scheme of things is a pretty small piece of the total cost of operating a hospital," according to the Journal News. "Most of the hospital costs are related to services, related to patient care."
(See "footprints" again. I call this argument bullshit.)

1 comment:

  1. Oops!
    The cat is getting out of the bag....


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