How to Save Billions On Health Care Now

Dr. Jon LaPook Looks At Remedies To Ballooning Health Care Costs

(CBS)  President Obama has stressed the importance of "bending the cost curve" in order to put the brakes on galloping health care expenses that total $2.5 trillion a year and are increasing at six percent a year. The fastest way to do this is shockingly simple: carefully explain to patients the known risks and benefits of procedures.

Dr. Elliott S. Fisher, Director of Dartmouth's Center for Health Policy Research, estimates that 30 to 40 percent of elective procedures are unnecessary. This includes elective angioplasty ($16,000), spinal fusion ($22,300), knee replacement ($14,400), and hip replacement ($15,700).

And it's not just costly procedures that are ballooning our health tab; the annual price for diagnostic imaging studies such at CT's and MRI's is about $100 billion, roughly 35 percent of which is estimated to be wasted.

A prime example of an overused procedure is angioplasty, which opens up clogged arteries in the heart. Over a million are performed every year in the United States. Most patients believe it will prevent a heart attack and prolong life. But that's only true if the procedure is performed when a patient is actually showing signs of a heart attack. In elective cases which, according to the American College of Cardiology's National Cardiovascular Data Registry, account for 37 percent of angioplasties, it has not been shown either to prevent heart attack or prolong life. For a segment that aired last June on the CBS Evening News with Katie Couric, cardiologist Dr. Steven Nissen of the Cleveland Clinic told me, "Cardiovascular interventional procedures are big money makers for hospitals and for practitioners." For a lot of doctors, "it's tough to walk away from that."

Our fee-for-service payment system certainly creates perverse incentives for doctors, a major reason for the spiraling cost of health care. But there is another factor that is more insidious: the reluctance of physicians to accept new evidence about the medicine they practice. For example, doctors have been taught for many years that an open artery is always better than a closed one. Despite convincing data showing that this simply isn't true, many physicians remain unconvinced and refuse to change their behavior.

When I interviewed President Obama about health care in July, I asked him about unnecessary elective angioplasties and the friction between what a physician believes to be true and what is supported by evidence-based medicine. He replied, "I have enormous faith in doctors. I think they always want to do the right thing for patients. But I also think, if we're honest, doctors, right now, have disincentives to making the better choices in the situations you talked about. If you are getting paid more for the angioplasty, then that subconsciously even might make you think the angioplasty is the better route to take. And so if we're reimbursing the physician not on the basis of how many procedures you're performing but rather how are you caring for the patient overall - what are the outcomes - then I think you start seeing some different choices."

Trying to figure out which medical interventions actually work is the whole point of the so-called "comparative effectiveness" studies for which Congress has budgeted $1.1 billion. There has already been good progress in this kind of research. Aside from data showing that elective angioplasties don't save lives, a recent study found that vertebroplasty, a common procedure to treat pain from back fractures, was no better than a placebo treatment with a shot to temporarily numb the area.

Ultimately, insurers will try to change behavior by refusing to cover services that have performed poorly in comparative effectiveness research. That strategy will likely take years to implement and will be complicated by the fact that medicine is both an art and a science and will never be able to be reduced to perfectly predictable algorithms. Clinical judgment and even what has recently become a politically incorrect term - intuition - will always play an important role.

So how do we save billions starting now? By doctors and patients agreeing to discuss carefully whether procedures and tests are worth it.

This will have to involve consent forms. A review of hundreds of these forms at more than 150 hospitals found them to be of "limited value." They are loaded with confusing language, often omit specific risks and benefits, and are generally not well explained by doctors. Patients often sign the forms minutes before a procedure without even reading them. Experts such as Dr. Fisher say that 30-40 percent of unnecessary procedures could be eliminated through proper informed consent - what is increasing being called "informed patient choice" to emphasize that doing the suggested procedure is not a foregone conclusion.

Gerry O'Connor, PhD, Associate Dean for Health Policy and Clinical Practice at the Dartmouth Hitchcock Medical Center, has implemented a pilot program that personalizes the consent process. In the case of angioplasty, the physician collects detailed medical information about a patient, then searches a database of angiogram results to estimate individual risks and benefits by finding out what happened to similar patients who had the same procedure.
"It's not generic," he told me. "It's for people like you. If we get that right, we'll create a better informed consent."

Ultimately, electronic medical records will connect with electronic medical knowledge, including comparative effectiveness results, to give doctors and patients information - so-called "decision support" - at the moment a test or procedure is electronically ordered. But until then, and starting immediately, doctors and patients can try the low-tech solution of setting aside enough time to weigh adequately the pros and cons of medical options - not just for procedures but for other treatments and diagnostic studies. Of course, this is more easily said than done in a system that reimburses far better for doing things to patients than for communicating with them. That must change.

In this week's CBS Doc Dot Com, I talked to Trudy Lieberman, the director of the health and medicine reporting program at CUNY's Graduate School of Journalism. She also blogs on health reform for the Columbia Journalism Review. Click below to watch the segment:


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[pnrn1]

A National Healthcare System in our lifetime is inevitable, and there is nothing anyone can do about it. There is simply too much pressure form the world to change the way we do business here in America, and frankly capitalism and corporate bottom lines are not a valid argument against a public option, or national healthcare system. I don't like it anymore than you do, but the writing is on the wall. Sure we lead the world in technological and pharmaceutical advancements, but as one poster mentioned, we are no closer to curing cancer than we were 50 years ago. As a result of the Billions spent on research, we can now give impotent old men erections, and grow hair, and suck the fat out of our flabby butts, but can't help Alzheimer's patients or ALS sufferers. With 16.2% of our GDP(2007)going toward healthcare (approx $7,500, per resident), we should not be ranked 37th out of 191 nations for performance of our healthcare system.
There should not be forty-five-million Americans without ANY form of health coverage. I'll say that again. 45,000,000 Americans have no health insurance, because they can't afford private insurance, nor do they meet Medicaid or Medicare's requirements. So what, they just get sick and die? Oh well, sorry poor person, you can't have the good medical care, and have to die because the buck stops at the bottom line.
Pathetic.

[jacknancy]

Best way is to go generics. I save my money by getting generic medications from a reputable online pharmacy called International Drug Mart.

I feel going generics is the best way.

[korboi]

HEALTHCARE REFORM PROVIDES AN OPPORTUNITY TO BUILD A 21st CENTURY INFRASTRUCTURE SERVICES FOR: SMART GRIDS, HEALTHCARE IT, BROADBAND, ETC.

We need to Used the Stimulus Funding for Healthcare Reform, to build Smart/Intelligent Infrastructure Services, that will Enabled Immediate New Jobs Creation, Economic Recovery, as well as have a Nationwide 21st Century Infrastructure.

For decades, Microsoft's Application have Increased Prooductivity, Efficiency, and Costs Savings in the Work Place.

Proper Deployment of Health Infrormation Technology (HIT) Solutions and Training can Increased productivity (i, e, medical data mining/warehousing, risks treatment, service delivery), Efficiency (i, e, medical errors, redundant and inappropriate care), and have a Costs Savings of around 20-30% of our Annual National Healthcare Expenditures ($2.4 Trillions).

The Engine of Economic Growth in this 21st Century is "Broadband." We can start by, Deploying a pure Packet-based, All Optical/IP, Multi-Service National Transport Network Infrastructure, using Ethernet throughout this national "Network of Networks."

The Investment in this Next Generation "Network of Networks", in addition to new jobs crreation and economic recovery, and also Serve as a Business Driver for: e-Healthcare, e-Commerce, e-Education, Energy Systems, Transportation Systems, Social Networking, Entertainment, etc.

This type of Investment is like the Investments that were made in the past, in Electrification of Rural Areas, and the Narional Transportation Inter-State Highways, which Increased Productivity, and our GDP.

Please See: www.gkquoquoi.blogspot.com for Summary Deployment Plan, for the Nationwide Health Information Network (NHIN).

Gadema Korboi Quoquoi
President & CEO
COMPULINE INTERNATIONAL INC.

[mcapek]

I wish you lunatics that foist this high tech on doctors would first fix such annoying and time consuming problems, such as doctor having to sign into computer system ohhh about 60 times a day, because of some loonie government mandated requirement to keep the patient info secret. An intelligent approach would be to provide a proximity device that instantly autosigns the doctor into the system, but NOOOOO....that is way to complicated, and what do we care about wasting doctors worthless time? Fix your crappy, unreliable, hard to use medical info software, that does not talk reliably to any other software in the hospital, while you are at it, you geniuses!

[zassy25]

today i wake into a medicaid office to apply for insurance and i was declin cause im unemployment and they give me 450 bi-weekly with tax out is 404 and a month is 808 my rent is 922 dollar my boyfriend give me 300 for the rest of the things and i have to paid my doctor bill every visit is 75 dollar any test is 200 dollar and i being Diagnosi with mass and cyst on my ovaries so i need to see my doctor ..for a biopsy and fallow up to make sure is not cancer..how you think im going to survive with 808 a month and paid my bill and doctors food.my doctor alist said paid little by little but i feel bad cause i have a bill big to paid him and now these problem..and im 25 i want to work but jobs out here are hard to find .. i dont need kid to have medicaid cause the the first thing they ask .. do you have any children the make me feel so sab cause the problem the i have idont get pregnat.. or are you disable i be no i want to work i dont want to be disable im only 25 and a live to life..so i was denied i was crying i wanted to died.. on the moment ..and they was i did all what i can to help you but .. you make to much money so i would not even bather to feel the application for medicaid just cause im getting 808 dollas a month how it these possible sunday i want to have a family i want my health and i want to be like everyone else happy and be able to get a future ..people just ell me just take everything out ...but i want a family just like everyone else have they come home to their wife and kid . and that smile make the day for them please if someone read these help me i would be very appreciated and god bless cause i now there is help out there for me even if i need to implant those egg and then have segury to have my tube remove but after i have alist a baby and i wont ask for more i have a perfect boyfrined all the time he ask married me i said no cause i wont be able to give him a family please help... my email is [e-mail]...thank you and god bless

sinceraly
Juana Baez

[odiecologne]

In my humble opinion age discrimination should have nothing to do with medical procedures. What qualifies as quality of life for one person may be different for another. MD's are not GODS they are Human beings. A very reputable physician told me yesterday, the wait time at a local hospital's ER was 60 hours. Not a typo I repeat 60 hours. Looks like a good follow up for 60 Minutes, like that will happen, maybe when pigs fly. Makes me wonder if Health Services are reformed will wait time be 600 hours? Or do you need to start making appointments for ER treatment? I feel certain Mr.Tom Leahy and Mr. Ed Joyce would give me the go ahead.

[endurorob_5]

Why is it that the liberals constantly attack the insurance companies for there costs. Try dropping your insurance and paying your medical costs out of pocket. The driving force in medical costs is the cost of treatment. The cost of insurance is just a by product of that. You people scream and yell about the profits insurance companies make (which by the way is the reason they exist, to make profits) but say very little about the profits doctors and hospitals make, and actually defend the profits of lawyers who help people file B.S. lawsuits. Why do you libs feel the need to dump 95% of the blame on insurance conmpanies? Because Pelosi, Reid, and Obama tell you to.

[skepticalJM]

You can save Billions in future Health Care very easily:
Just Ban Tobacco products from being sold in the United States.

[endurorob_5]

Yes, ban tobacco produsts, ban meat products, ban sugar products, ban sports. What else shall we ban comrade. Don't forget the alcohol.

[nomealaska]

America has developed a complex system that favors corporate profits over health. We used to eat from small farms and eat better food, and we had increasing life spans as medical procedures and diagnosis improved. Now, we commute more, eat the cr*p that lines the grocery store aisles instead of locally-grown foods, and get healthcare from an overgrown system that pushes overpriced drugs and procedures in an attempt to find a new balance with our unhealthy habits. Corporate greed is the core of the problem. Prepared food is necessary because we are working so much, we don't make time to prepare healthier meals. Doctors are pill pushers, inspired by the pharmaceutical companies which tell us to ask our doctor for them. They justify the high prices (in America) to promote new research/drug development, but we bear the full burden as they sell the same drugs in other countries for pennnies. The system isn't about health, it is about money.

[Stevenapoli7]

The paradox is you are complaining about drug companies when we the U.S. should support them. We shouldn't let Canada strong arm them into cheap drugs making us pay more. We should share the cost equally.

[John_Merritt]

I will tell you right now the insurance industry has done NOTHING to rein in their 'in office' costs, their productivity is poor at best. The money they spend on their lobbyists is OBSCENE and they need to take more responsibility for their cost reduction measures. What better way to improve system efficiencies than to require them to use practices they have required of hospitals and clinics in reducing costs.

There is little reason that 'the industry' be given a free ride to do what they want at the expense of everyone else (doctors, hospitals and patients) and yet their internal gevernance is lacking in all respects. We can talk about Wall Street all we want, but what the Insurance Industry has done to the American landscape is criminal in the field of business.

Blatant disregard for everything American businesses rely on everyday, has eluded their way of thinking and it is time they are held accountable. That is the best way to reduce the expense of this bill right now. Make everyone accountable so that we are paying for actual costs and not perceived benefit to them.

[endurorob_5]

Currently no one is being forced to contribute to the profits of insurance companies. You can drop your insurance and pay your medical costs out of pocket. You do not need to use the money saving service provided by health insurance comapanies.

[ajvw]

@endurorob_5

be careful, you're advocating personal responsibility and that's not allowed on these pages

[endurorob_5]

lovenpeace1 November 12, 2009 1:12 PM EST
Viva la Capitalismo with it Greed!

Capitalism has no heart for health care and education.


The ones you consider the gready ones are the ones aerning money and paying taxes to support the true greedy which are the ones who pay no taxes and take advantage of social services.

[lovenpeace1]

Viva la Capitalismo with it Greed!

Capitalism has no heart for health care and education.

[Mortarman-29]

Capitalism is what created and pays for great haelthcare. Without profit, no one risks their own money and time to make something new.

So, capitalism is the biggest "heart" you can have. All socialism does is share the misery.

[endurorob_5]

Our capitalist system creates the greatest advancements in healthcare. If we go the way of Canada and Europe you can forget about the advances in health care that save lives. Under universal health care there is no money for research.

[skepticalJM]

Health Care is just exactly the same as it was 50 years ago. Big machines and fancy scans don't save lives. What saves lives is preventing serious illness, by getting regular checkups. This is exactly where fancy medicine fails --- it makes medicine so expensive no one wants to go to the doctor till there half dead.
Have they found a cure for cancer, with all the Billions in research dollars they have spent? No, they are using the same shotgun techniques they were using 50 years ago. We don't need digital diagnosis or thousand dollar scans to find the same things that good doctors were finding 50 years ago; we need good Doctors who care about their patients instead of making money.

[Stevenapoli7]

Oh really? Then why do the vast majority of medical breakthroughs happen in the U.S. ?

[Mortarman-29]

Wake up America.

[jtdev1]

6% ???

Where did they get that from?

My health care cost (United Health Care EPO - Family) went up 13.89% for the 2010 calendar year.

My co-worker's (United Health Care EPO - Single) went up 22.01%


Talk about skyrocketing health care costs...

I've had enough of this. I can't afford to be paying more for Health Insurance than I pay in Federal Taxes or My House Mortgage...


Universal Health Care NOW!
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Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!
Universal Health Care NOW!

[Mortarman-29]

Sheep being led to slaughter. Unbelievable.

[brian1920]

you can thank MEDICARE for your rate increases. The government cut payment and the hospitals charged you the difference. Of course MedICARE is 8 times over projected budget so it is just another screwed up government program with $60B/yr. in fraud.

[luadda22]

jtdev1, so because you cannot afford to be paying more for health care, you want to use the power of government to force me to help you pay for it. I hope I get a Christmas card from you "comrade".

[endurorob_5]

If you can afford the insurance just drop it and try paying out of pocket for your health care.

[Stevenapoli7]

Hey mac, that will be just as expensive, and even more as time goes on.

[bill0bob]

"... after all there is no evidence that they worked just because you never got polio or small pox" -- ObamaYoMama

Let me guess... you aren't a big fan of science because you don't understand it and that scares you.

[TheStolenGiraffe]

i never understood why people are against a public option. this bill is going to legally force every citizen who doesn't have or can't afford insurance to purchase it through gov't subsidies. this means big bucks in the pockets of private insurance companies because they will soon collectively have every citizen in this nation as a policy holder. why shouldn't the gov't have their own insurance to compete to keep prices low, and at least put some of the money they're handing out to people for insurance back into treasury?

sounds to me like those who are against a public option are simply just speaking out for the lobbyists of greedy insurance companies who want to keep all of the profit from the huge influx of new customers that will come to them through this bill.

[azfalcon]

I don't know if you really steal giraffe's - but you seem to have no qualms about stealing peoples money. Let me answer what you do not understand this way.... Why not just take ALL your money and assets and let some government entity make all your decisions for you? It's the same concept - the only difference is in the scale.

[Mortarman-29]

What dont you understand that:

1. It is illegal for the Federal government to do so
2. We dont want the Federal government involved in our healthcare, except for regulation interstate commerce part

So, let's start with those two. I would rather the Federal government obey the law.

[luadda22]

"Money back into the treasury"????? What planet are you from? The govenment compete??? I don't know what business you're in or work for, but if I went into competition against you and did not have to worry about making a profit and ran at a loss using other peoples money that I didn't have to pay back. I'd have you on the street within days.

[ObamaYoMama]

This is why people are scared of healthcare reform. How can you say that kneee replacement surgeries are not effective? Who did these studies, the insurance companies? And, OMG, tell me how anyone can say that an elective stent didn't prolong life or prevent a heart attack? This sounds like te same logic that says vacines dodn't work, after all there is no evidence that they worked just because you never got polio or small pox... I am all for health care reform but this kind of talk scares the hell out of me!!!

[us_1776]

It's not different that when you go to the auto-repair shop and they tell you that you need $775 worth of other repairs or your car might be too dangerous to drive. They market all these extra procedures and imaging through subliminal scare tactics. Most of it does nothing to actually improve the patients health.

[crikeytx46]

Get used to this kind of talk if the Government Health Care Bill passes!!

[mcapek]

Comarade, just because you have horrible hip pain due to severe osteoarthritis, is no reason why you should be getting a new hip joint, or scooter from Scooter Store! Learn to be tough, a put up with it. Pair of cheap Chinese crutches for you..