Wednesday, March 28, 2018

Waste Not, Want Not

A phrase used as a way to advise someone not to waste anything, because they might need it in the future and that applies in the case of medical care.

The exploitation and opportunity wasted regarding how deeply flawed our medical system is not wasted.   Over the last few days CBS investigated a group buying up failing rural hospitals and in turn billing tests to outside labs which they also owned or had investment interest in and were receiving reimbursements at over 100% payback on claims.  Gosh think you get refused or have a significant deductible before you can get covered, these guys had it down.

Then we have the Surgeons and others pushing on patients unnecessary tests and treatments under the idea that it was to prevent them from malpractice litigation.  Meanwhile filing and actually doing a medical malpractice suit across the country has become literally impossible so that is another one we can call BS on.  The reality is that in the pay for play deals that are often established and in turn hospital for profit management demands this as a means to generate funds.  As who wants to be a failing hospital?

This comes from ProPublica one of the few sites of investigative journalism left in the U.S. and they dedicate a reporter to the medical industrial complex to cover how we are paying more for medical care and getting less results than any other industrialized nation.  

This study comes from my former home state and I sued a Hospital and their Physicians on my own with regards to neglect of care and abuse.  The University of Washington and their role at Harborview Medical Center in Seattle is a dump, largely funded by being the number one Trauma Center for several states and in turn the city requiring everyone to go to one place in which to be exploited and dumped if poor.  They are a shithole with a history of shit.  

It is also the home of Swedish Medical Centers that had a neurosurgeon that was so dangerous the staff demanded action and asked the largely ineffectual Medical Board of the State to rescind his license to practice.  Seattle is great if you don't get sick.

Unnecessary Medical Care Is More Common Than You Think

A study in Washington state found that in a single year more than 600,000 patients underwent treatment they didn’t need, at an estimated cost of $282 million. “Do no harm” should include the cost of care, too, the report author says.

by Marshall Allen Feb. 1,2018
Wasted Medicine
Squandered Health Care Dollars

This story was co-published with NPR’s Shots blog.

It’s one of the intractable financial boondoggles of the U.S. health care system: Lots and lots of patients get lots and lots of tests and procedures that they don’t need.

Women still get annual cervical cancer testing even when it’s recommended every three to five years for most women. Healthy patients are subjected to slates of unnecessary lab work before elective procedures. Doctors routinely order annual electrocardiograms and other heart tests for people who don’t need them.

That all adds up to a substantial expense that helps drive up the cost of care for all of us. Just how much, though, is seldom tallied. So, the Washington Health Alliance, a nonprofit dedicated to making care safer and more affordable, decided to find out.

The group scoured the insurance claims from 1.3 million patients in Washington state who received one of 47 tests or services that medical experts have flagged as overused or unnecessary. What they found should cause both doctors and their patients to rethink that next referral. In a single year:

More than 600,000 patients underwent a treatment they didn’t need, treatments that collectively cost an estimated $282 million.

More than a third of the money spent on the 47 tests or services went to unnecessary care.

Three of four annual cervical cancer screenings were performed on women who had adequate prior screenings — at a cost of $19 million.

About 85 percent of the lab tests to prep healthy patients for low-risk surgery were unnecessary — squandering about $86 million.

Needless annual heart tests on low-risk patients consumed $40 million.

Susie Dade, deputy director of the alliance and primary author of the report released Thursday, said almost half the care examined was wasteful. Much of it comprised the sort of low-cost, ubiquitous tests and treatments that don’t garner a second look. But “little things add up,” she said. “It’s easy for a single doctor and patient to say, ‘Why not do this test? What difference does it make?’”

An epidemic of unnecessary treatment is wasting billions of health care dollars a year. Patients and taxpayers are paying for it.

ProPublica has spent the past year examining how the American health care system squanders money — often in ways that are overlooked by providers and patients alike. The waste is widespread — estimated at $765 billion a year by the National Academy of Medicine, about a fourth of all the money spent each year on health care.

The waste contributes to health care costs that have outpaced inflation for decades, making patients and employers desperate for relief. This week Amazon, Berkshire Hathaway and JPMorgan rattled the industry by pledging to create their own venture to lower their health care costs.

Wasted spending isn’t hard to find once researchers — and reporters — look for it. An analysis in Virginia identified $586 million in wasted spending in a single year. Minnesota looked at fewer treatments and found about $55 million in unnecessary spending.

Dr. H. Gilbert Welch, a professor at The Dartmouth Institute who writes books about overuse, said the findings come back to “Economics 101.” The medical system is still dominated by a payment system that pays providers for doing tests and procedures. “Incentives matter,” Welch said. “As long as people are paid more to do more they will tend to do too much.”

Dade said the medical community’s pledge to “Do no harm” should also cover saddling patients with medical bills they can’t pay. “Doing things that are unnecessary and then sending patients big bills is financial harm,” she said.

Officials from Washington’s hospital and medical associations didn’t quibble with the alliance’s findings, calling them an important step in reducing the money wasted by the medical system. But they said patients bear some responsibility for wasteful treatment. Patients often insist that a medical provider “do something,” like write a prescription or perform a test. That mindset has contributed to problems like the overuse of antibiotics — one of the items examined in the study.

And, the report may help change assumptions made by providers and patients that lead to unnecessary care, said Jennifer Graves, vice president for patient safety at the Washington State Hospital Association. Often a prescription or technology isn’t going to provide a simple cure, Graves said. “Watching and waiting” might be a better approach, she said.

To identify waste, the alliance study ran commercial insurance claims through a software tool called the Milliman MedInsight Health Waste Calculator. The services were provided during a one-year period starting in mid-2015. The claims were for tests and treatments identified as frequently overused by the U.S. Preventive Services Task Force and the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The tool categorized the services one of three ways: necessary, likely wasteful or wasteful.

The report’s “call to action” said overuse must become a focus of “honest discussions” about the value of health care. It also said the system needs to transition from paying for the volume of services to paying for the value of what’s provided.

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