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Wasted Health Care and What We Can Do
Innovation should produce efficiencies and cut waste.

Prescription arthritis medication Humira

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Marc Siegel

America’s health-care system is laden with waste — $750 billion of it each year, according to a shocking new report from the Institute of Medicine. The key reason found was complexity; health-care systems are too complicated these days for providers to fully integrate new technologies and treatments meant to help patients without increasing costs. At the same time, complex chronic diseases are on the rise, putting even more pressure on doctors and nurses to handle many aspects of a patient’s health care at the same time.

These are pressures we can’t possibly handle.

Waste is inevitable because of poor teamwork, inflated pricing, thick-as-a-steak bureaucracy, and excessive duplication. Further, fear of malpractice lawsuits compels doctors to overreact and overtreat when confronted with very sick patients. Many doctors are also not great communicators, and are creatures of habit, so an inordinate amount of time is spent learning to communicate about new tests and treatments with nurses, patients, or each other.

Effectively treating a very sick patient with the latest technology should be a happy success for health-care providers, but the already-overburdened system makes it into an onerous challenge. Take “Harold,” a 70-year-old patient with rheumatoid arthritis who received such state-of-the-art care that it was practically his undoing.

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When Harold had a flare-up of his rheumatoid arthritis, causing his joints to swell, he was placed on a newer drug known as a biologic (made from a living organism). He responded well, but the drug he was given, Humira, had to be replaced with a similar drug, Enbrel, when his insurance failed to cover the cost of Humira. The patient responded well to Enbrel too, but he discontinued that as well when he couldn’t afford an increase in the co-payment. Harold’s rheumatologist put him on methotrexate, an older drug (and chemotherapy agent), which is also effective against his disease, but in Harold’s case the drug caused bruising and bleeding. He was forced to go to the hospital, where he was found to have a low platelet count and was admitted for intravenous steroid treatment.

Thousands of dollars and hundreds of hours of expensive care later, Harold was restarted on Humira, after his insurer finally responded to multiple physicians’ appeals and agreed to absorb the cost. Dozens of health-care providers were involved along the way, many of whom didn’t know the full case. It took time before the patient’s doctors realized he was having side effects from the methotrexate and more time before they appealed to the insurance company for the original drug that had worked. Luckily, Harold survived, and the only real long-term cost was financial.

This example of waste is not unique. It takes time for insurers to begin covering newer expensive treatments, even life-saving ones, as a matter of routine. It also takes time to understand the treatments’ proper uses and time for doctors and hospitals to learn to work with them efficiently.

The solution to the problem, according to IOM, lies in innovative practices. In my opinion, these innovations should be introduced in the private sector, where the profit motive incentivizes efficiency, better communication, uniform and transparent prices, and a patient-centered approach (all good suggestions found in the IOM report). These benefits hold true whether the business is a hospital or an insurance company or a doctor’s office practice. For example, the price a hospital charges an insurer for performing a CT or MRI scan would vary less from one hospital to the next if the prices were transparent and open to competition. A surgical team which includes a dietician, a pain-management nurse, and a social worker could focus on improving a patient’s diet, reducing his pain, and promoting a timely discharge. Finally, if a patient like Harold were able to appeal his medication needs directly to the insurer, the decisions made might be more tailored to his actual needs.

In contrast, Obamacare’s new regulations will increase inefficiency by adding more hoops for doctors and patients to jump through. Federal committees or boards can’t provide guidance on a case-by-case basis, and thus can’t possibly respond to the nuances of a patient like Harold. More regulations also hold back innovations by stifling creative business solutions.

Major medical centers such as the Cleveland Clinic and the Mayo Clinic have long had patient-centered teams that work efficiently and save the hospital money. At my medical center, nurse practitioners, nurse managers, well-integrated teams, and computerization of records have greatly improved communication and efficiency, to the point where many doctors who leave solo practice to join the faculty (a group practice) are better off, benefiting from working with a well-oiled machine.

Patients benefit from receiving all their health care under one roof, where records are readily accessible to doctors and nurses, where immediate access is available to the latest innovations, and where billing is transparent and fair.

If quality medical care is to survive in America, this is what it must look like.

— Marc Siegel, M.D., is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical correspondent and author of The Inner Pulse.



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