Comments on: Toxic Waste In The U.S. Health System http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/ The Policy Journal of the Health Sphere Tue, 07 Feb 2012 22:23:43 +0000 hourly 1 By: DrEric http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/comment-page-1/#comment-22910 DrEric Thu, 24 Jul 2008 23:04:06 +0000 http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/#comment-22910 As for Dr. Milstein's #4 way to improve healthcare efficiency "incentivizing consumers to choose higher-value treatment options and providers," I think it is a good strategy, but requires consumer support. Patients need cost comparisons for drugs, tests and procedures at the time and place where care decisions are being made. A consumer can be incentivized with a consumer directed health plan, but he also needs to know what the alternatives to Cozaar ($59/month) cost when the doctor is writing the prescription (a viable alternative, Lisinopril costs $4/month). Patients also need qualtiy comparisons and given the controversial and nebulous world of quality measurement, some of the most relevant quality measures are (1) is the office staff competent (2) can I get in the door to get an appointment and (3) has my doctor ever been sanctioned by the state medical board. As a selfish plug, I work for a company that provides these type of support services for patients, but our customers are saving money and really like the doctors they go to. As for Dr. Milstein’s #4 way to improve healthcare efficiency “incentivizing consumers to choose higher-value treatment options and providers,” I think it is a good strategy, but requires consumer support. Patients need cost comparisons for drugs, tests and procedures at the time and place where care decisions are being made. A consumer can be incentivized with a consumer directed health plan, but he also needs to know what the alternatives to Cozaar ($59/month) cost when the doctor is writing the prescription (a viable alternative, Lisinopril costs $4/month). Patients also need qualtiy comparisons and given the controversial and nebulous world of quality measurement, some of the most relevant quality measures are (1) is the office staff competent (2) can I get in the door to get an appointment and (3) has my doctor ever been sanctioned by the state medical board.

As a selfish plug, I work for a company that provides these type of support services for patients, but our customers are saving money and really like the doctors they go to.

]]> By: ljohns http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/comment-page-1/#comment-22325 ljohns Mon, 16 Jun 2008 22:06:08 +0000 http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/#comment-22325 Symbolic anecdote. I always ask for cc of MD's report on any diagnostic procedure. Received one two weeks ago that included an ICD-9 code for a serious symptom I did not present and do not have. A supervisor from my medical group and I, querying the billing clerk at the practice, heard this: "Oh, we always add that code because it makes insurance payment more certain. " My referring MD, apprised of this upcoding, says she wishes they didn't but everybody does it. Efficiency improvement? "Value purchasing?" Hard to imagine under FFS payment and its corrupting incentives. Lucy Johns, MPH Symbolic anecdote. I always ask for cc of MD’s report on any diagnostic procedure. Received one two weeks ago that included an ICD-9 code for a serious symptom I did not present and do not have. A supervisor from my medical group and I, querying the billing clerk at the practice, heard this: “Oh, we always add that code because it makes insurance payment more certain. ”

My referring MD, apprised of this upcoding, says she wishes they didn’t but everybody does it.

Efficiency improvement? “Value purchasing?” Hard to imagine under FFS payment and its corrupting incentives.

Lucy Johns, MPH

]]> By: richard smith http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/comment-page-1/#comment-22174 richard smith Sat, 07 Jun 2008 01:36:31 +0000 http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/#comment-22174 Lets look and the cost and productivity of the healthcare consulting industrial complex. Unregulated. No qualifications. No reporting. Massive costs. Lack of accountability. Lack of productivity as far as outcomes go, except to generate massive paper justification for its own impenetrable opaque/"transparency." Lets look and the cost and productivity of the healthcare consulting industrial complex. Unregulated. No qualifications. No reporting. Massive costs. Lack of accountability. Lack of productivity as far as outcomes go, except to generate massive paper justification for its own impenetrable opaque/”transparency.”

]]> By: john saarikko http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/comment-page-1/#comment-22143 john saarikko Thu, 05 Jun 2008 14:08:37 +0000 http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/#comment-22143 All of the above is basically correct but you are just putting a finger into the hole in the dike. There is no way you can institute any meaningful improvement as long as you are working with an investment bank hell bent on making profits. Those investment banks are the insurance companies - the NCL (Non Contributing Layer) to healthcare delivery. One needs only to go to one of their 10-K filings and see what its all about. Until you get the total picture small improvements do nothing. Go see - hit the last tab NCL: http://www.universalhealthcareinfousa.com All of the above is basically correct but you are just putting a finger into the hole in the dike. There is no way you can institute any meaningful improvement as long as you are working with an investment bank hell bent on making profits. Those investment banks are the insurance companies – the NCL (Non Contributing Layer) to healthcare delivery.

One needs only to go to one of their 10-K filings and see what its all about. Until you get the total picture small improvements do nothing. Go see – hit the last tab NCL:

http://www.universalhealthcareinfousa.com

]]> By: NEHI http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/comment-page-1/#comment-22104 NEHI Tue, 03 Jun 2008 19:17:53 +0000 http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/#comment-22104 Speculation abounds on where the wasted one-third of our health care dollars is going, but now there is actual evidence. The New England Healthcare Institute (NEHI) recently took up the questions of where the waste is, why it exists and how much there is, publishing three reports on the topic (available at www.nehi.net). We identified six areas of waste which, if eliminated, would offer significant potential cost savings: 1. Unexplained variation in the intensity of medical and surgical services such as overuse of coronary artery bypass surgery (CABG), with potential savings up to $600 billion; 2. Misuse of drugs and treatments, resulting in avoidable adverse effects, with potential savings of $52.2 billion; 3. Overuse of non-urgent emergency department care that could save (conservatively) $21.4 billion; 4. Underuse of appropriate medications, including generic hypertensives, with potential savings of $3 billion; 5. Underuse of controller medicines in pediatric asthma, with projected savings of $2.5 billion; and 6. Overuse of antibiotics for respiratory infections, with potential savings of $1.1 billion. NEHI also examined the lack of adoption of evidence-based practice guidelines by physicians, finding four significant barriers: lack of accessible guidelines at the point of care; underuse of information technology to make guidelines more broadly available; the payment system’s tie to procedure volume versus outcome quality; and the physician culture, which rewards use of judgment versus comparative feedback. Knowing where health care waste is, why it exists and how many dollars are wasted are prerequisites for removing it from the system, but until now, we have not had a rigorous compilation of this type of evidence. Taken together, the evidence demonstrates that our health care system can and should do better – and challenges each sector to confront the physical and financial harm of wasteful, inefficient and poor-quality care. -Wendy Everett, President, NEHI Speculation abounds on where the wasted one-third of our health care dollars is going, but now there is actual evidence. The New England Healthcare Institute (NEHI) recently took up the questions of where the waste is, why it exists and how much there is, publishing three reports on the topic (available at http://www.nehi.net). We identified six areas of waste which, if eliminated, would offer significant potential cost savings:

1. Unexplained variation in the intensity of medical and surgical services such as overuse of coronary artery bypass surgery (CABG), with potential savings up to $600 billion;
2. Misuse of drugs and treatments, resulting in avoidable adverse effects, with potential savings of $52.2 billion;
3. Overuse of non-urgent emergency department care that could save (conservatively) $21.4 billion;
4. Underuse of appropriate medications, including generic hypertensives, with potential savings of $3 billion;
5. Underuse of controller medicines in pediatric asthma, with projected savings of $2.5 billion; and
6. Overuse of antibiotics for respiratory infections, with potential savings of $1.1 billion.

NEHI also examined the lack of adoption of evidence-based practice guidelines by physicians, finding four significant barriers: lack of accessible guidelines at the point of care; underuse of information technology to make guidelines more broadly available; the payment system’s tie to procedure volume versus outcome quality; and the physician culture, which rewards use of judgment versus comparative feedback.

Knowing where health care waste is, why it exists and how many dollars are wasted are prerequisites for removing it from the system, but until now, we have not had a rigorous compilation of this type of evidence. Taken together, the evidence demonstrates that our health care system can and should do better – and challenges each sector to confront the physical and financial harm of wasteful, inefficient and poor-quality care.

-Wendy Everett, President, NEHI

]]> By: NEO River / links for 2008-06-03 http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/comment-page-1/#comment-22103 NEO River / links for 2008-06-03 Tue, 03 Jun 2008 17:02:44 +0000 http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/#comment-22103 [...] Toxic Waste in the U.S. Health Care System For most of these predominantly low-to-middle-income Americans, the underlying problem is not lack of desire for health insurance; rather. their income is insufficient to reasonably afford a health insurance policy or pay its deductible and other out-of-p [...] [...] Toxic Waste in the U.S. Health Care System For most of these predominantly low-to-middle-income Americans, the underlying problem is not lack of desire for health insurance; rather. their income is insufficient to reasonably afford a health insurance policy or pay its deductible and other out-of-p [...]

]]> By: alliek http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/comment-page-1/#comment-22088 alliek Mon, 02 Jun 2008 19:48:12 +0000 http://healthaffairs.org/blog/2008/06/02/toxic-waste-in-the-us-health-system/#comment-22088 You speak of trimming the health care industry's fat. Absolutely. That's something that I think NEEDS to be done, especially considering the recent economic woes. The question is, though, where should we trim the fat? Should it be in R&D? Most people will say, "Of course not." Should it be in market research, lobbying, and sales? Absolutely. Let's <a href="http://www.health-insurance.org/health-insurance-lobbyists" rel="nofollow">start with the insurance lobbying industry</a>, which spends 2.79 billion dollars a year. Once we're done with that, we can fix the records system so that it's actually in the 21st century. Considering the amount of money that's spent, we're falling behind, too. Apparently it takes <a href="http://www.health-insurance-2008.org/united-states-vs-canada.php" rel="nofollow">more people to administer coverage in Massachusetts</a> than the entire country of Canada. You speak of trimming the health care industry’s fat. Absolutely. That’s something that I think NEEDS to be done, especially considering the recent economic woes. The question is, though, where should we trim the fat? Should it be in R&D? Most people will say, “Of course not.” Should it be in market research, lobbying, and sales? Absolutely. Let’s start with the insurance lobbying industry, which spends 2.79 billion dollars a year. Once we’re done with that, we can fix the records system so that it’s actually in the 21st century.

Considering the amount of money that’s spent, we’re falling behind, too. Apparently it takes more people to administer coverage in Massachusetts than the entire country of Canada.

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