Health care waste and fraud

Here is a 60 Minutes broadcast on Medicare fraud that would make one's blood pressure go up:
http://www.cbsnews.com/video/watch/?id=5419844n

And here is an article about medical waste. The problem is other than eliminating duplicated tests by using electronic records, I really don't see any possible savings. I don't see doctors willing to risk malpractice insurance by ordering fewer tests. I don't see use of ER would reduce as long as we don't have enough primary care physicians. If the government is capable of catching the crooks, they would have done that already, with or without the current proposed health care reforms. What makes anyone think the current proposal would reduce the type of errors cited in this article?

The sad fact is that if we incur $60 billion worth of fraud in Medicare now, as cited by 60 Minutes, expanding that health care system to cover more people with a public option will no doubt increase fraudulent claims.

In my opinion, doctors in the U.S. spend more time on paperwork is because of the need for good documentation. Having good documentations serve two purposes. They provide better patient care and they can be used by the doctors to defend themselves in malpractice lawsuits.

And unless the government takes over the entire health care system, there will be needs for health care providers to continue sending billings.

http://news.yahoo.com/s/nm/20091026/ts_nm/us_usa_healthcare_waste_4
Healthcare system wastes up to $800 billion a year
By Maggie Fox, Health and Science Editor Maggie Fox, Health And Science Editor – 33 mins ago

WASHINGTON (Reuters) – The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.

The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters, found.

"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.

"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.

"The good news is that by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care."

One example -- a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending.

"It is waste when caregivers duplicate tests because results recorded in a patient's record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed," the report reads.

Some other findings in the report from Thomson Reuters, the parent company of Reuters:

• Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.
• Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
• Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.
• Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.
• Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.
  

"The average U.S. hospital spends one-quarter of its budget on billing and administration, nearly twice the average in Canada," reads the report, citing dozens of other research papers.

"American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than in Canada," it says, quoting a 2003 New England Journal of Medicine paper by Harvard University researcher Dr. Steffie Woolhandler.

Yet primary care doctors are lacking, forcing wasteful use of emergency rooms, for instance, the report reads.

All this could help explain why Americans spend more per capita and the highest percentage of GDP on healthcare than any other OECD country, yet has an unhealthier population with more diabetes, obesity and heart disease and higher rates of neonatal deaths than other developed nations.

Democratic Senator Charles Schumer said on Sunday that Senate Democratic leaders are close to securing enough votes to pass legislation to start reform of the country's $2.5 trillion healthcare system.
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Also see http://guywong.blogspot.com/2009/11/10-ways-to-cut-health-care-costs-right.html