Saving Billions without Electronic Health Records

The issue of one single set of rules for insurance billing was promulgated in the 1970s. It is now almost 40 years since this was proposed and someone is actually showing what many, including me, have been saying.

Note that is was always Big Insurances that created more layers, more paper, separate paper, and higher cost during this time.

Simpler medical billing saves $7 billion
BOSTON, April 29 (UPI) -- Simplifying and standardizing administrative procedures for medical bills could save about $7 billion a year, U.S. researchers estimate.

Bonnie B. Blanchfield of Massachusetts General Hospital in Boston and colleagues have created a hypothetical model for medical billing that involves a single set of payment rules for multiple payers, a single claim form and standard rules of submission.

If doctors' offices used the streamlined medical billing system they would save 4 hours a week of physician time and 5 hours a week of staff time, Blanchfield said.

The researchers analyzed the billing system of a physician's group affiliated with a large, urban, academic teaching hospital. The researchers found 12.6 percent of submitted claims are initially rejected, but 81 percent are eventually paid -- after using considerable staff time.

"The savings from reducing administrative complexity could be translated into decreased costs in general," the study authors said in a statement. "Mandating a single set of rules, a single claim form, standard rules of submission, and transparent payment adjudication-with corresponding savings to both providers and payers-could provide system wide savings that could translate into better care for Americans."

The findings are published in the journal Health Affairs at http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0075v1.

Costs Too Much, Get Too Lttle: US Health Care

The insurance industry wants to retain control over health care access, service and fees. No surprise!

Here in the US we are the only country that has insurance through employment. What we need is a mind set that puts people first, not profit, and not poor care at high cost.

Report: US on short end of health care 'value gap'
By RICARDO ALONSO-ZALDIVAR, Associated Press Writer
Mar 12, 2009

WASHINGTON – If the global economy were a 100-yard dash, the U.S. would start 23 yards behind its closest competitors because of health care that costs too much and delivers too little, a business group says in a report to be released Thursday.

The report from the Business Roundtable, which represents CEOs of major companies, says America's health care system has become a liability in a global economy.

Concern about high U.S. costs has existed for years, and business executives — whose companies provide health coverage for workers — have long called for getting costs under control. Now President Barack Obama says the costs have become unsustainable and the system must be overhauled.

Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.

In a different twist, the report took those costs and factored benefits into the equation.

It compares statistics on life expectancy, death rates and even cholesterol readings and blood pressures. The health measures are factored together with costs into a 100-point "value" scale. That hasn't been done before, the authors said.

The results are not encouraging.

The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.

The cost-benefit disparity is even wider — 46 points — when the U.S. is compared with emerging competitors: China, Brazil and India.

"What's important is that we measure and compare actual value — not just how much we spend on health care, but the performance we get back in return," said H. Edward Hanway, CEO of the insurance company Cigna. "That's what this study does, and the results are quite eye-opening."

Higher U.S. spending funnels away resources that could be invested elsewhere in the economy, but fails to deliver a healthier work force, the report said.

"Spending more would not be a problem if our health scores were proportionately higher," Dr. Arnold Milstein, one of the authors of the study, said in an interview. "But what this study shows is that the U.S. is not getting higher levels of health and quality of care."

Other countries spend less on health care and their workers are relatively healthier, the report said.

Medical costs have long been a problem for U.S. auto companies. General Motors spends more per car on health care than it does on steel. But as more American companies face global competition, the "value gap" is being felt by more CEOs — and their hard pressed workers.

One thing the report does not do is endorse the same solution that countries like Canada have adopted: a government-run health care system.

The CEOs of the Business Roundtable believe health care for U.S. workers and their families should stay in private hands, with a government-funded safety net for low-income people.
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On the Net: Business Roundtable: http://www.businessroundtable.org
Copyright © 2009 The Associated Press.

Scattershot method for determining best medicine

This article points to a 50% effectiveness for comparison shopping. Other studies have established that 80% of what is standard in health care doesn't work, and many providers just do not know why.

If this is where things are today, then it is going to be as slow as molasses in January to get a fire under change in health care.

I raised questions about ability to diagnose what ails you. I've also questions drug issues. It just seem as if no one really knows what is going on. And to top it off, doctor groups don't want people to be allowed to comment about them on line.

Is there a problem with free speech in medicine these days as well?

All I know is that for me this does not bode well, and I suppose I'd better get started on that book everyone wants me to write. The one with patient stories, the ones I hear every day from very frustrated people who are only trying to maneuver their way through the current system. They are just seeking preventive tools or better care from a provider who will at least talk with them - face to face.

HEALTHBEAT: What's the best medicine -- really?
By LAURAN NEERGAARD, AP Medical, Mar 9, 2009

WASHINGTON – Think your doctor knows which drug — or surgery or even diagnostic test — works best? Think again. Half the time, there's little if any good evidence comparing one to another. And one of medicine's little secrets is that brand-new drugs don't have to work any better than cheap old ones to be approved for sale.

Now the government has a $1.1 billion down payment to start unraveling that problem, money provided in the economic stimulus package to better determine which test or treatment works best, when and for whom so that patients don't waste time and money on poor choices.

But which ailments go to the top of a very long wish list? And perhaps most important, how to make sure the results get into doctors' and patients' hands but not overly limit what therapies people can choose?

"There's a lot of clamor ... that this is going to deprive people of the choice to basically have every treatment they want. That's based on a false premise," Dr. Harold Sox, past president of the American College of Physicians, told The Associated Press. Last week, Sox was chosen to lead a panel of the prestigious Institute of Medicine to help guide what comparisons the government makes.

"If people had a good explanation of why a test that they wanted was more likely to hurt them than to help them, they might of their free choice say, 'You know, I was clearly wrong. I shouldn't want that test and now I don't."

At issue is what's called "comparative effectiveness." Should you have open-heart bypass surgery or far less invasive stents to open severely clogged heart arteries? Which of two hot treatments best prevents stroke from a clogged neck artery, surgically rooting out the clog or pushing it aside with a stent?

Does arthroscopic surgery work any better than painkillers for knee arthritis? Of all the competing pills, which is best to start with in treating Type 2 diabetes or high blood pressure? Is there really any difference between Prevacid and Prilosec for heartburn, or between Fosamax and hormone treatments for bone-weakening osteoporosis?

Those winners-and-losers questions drive fierce opposition to comparison effectiveness research from drug makers and others who have a financial stake in the outcome and fear that insurers will use the results to make coverage decisions. Back surgeons once lobbied to kill the federal Agency for Healthcare Research and Quality after it found "insufficient evidence" supporting certain spine operations — not that they didn't work, just that more evidence was needed.

The result: The nation has a scattershot method for determining best medicine. The little-known AHRQ spends about $30 million a year reviewing evidence of select tests and treatments. The National Institutes of Health occasionally compares contested therapies in expensive, years-long studies involving thousands of patients, like the stroke trial now under way.

So an extra $1.1 billion for the government to start spending on such comparisons this year marks a huge jump. By June's end, the Institute of Medicine panel will provide a priority list of up to 50 vexing medical questions to help the feds determine where to start.

Don't expect easy answers. Federal scientists are acutely aware that many of today's studies don't account for wide variations in responses to treatments by minorities or other subgroups.

"We have not yet seen a report or an assessment that says, 'Option A thumbs up, Option B forget it,'" says AHRQ Director Dr. Carolyn Clancy. The goal is "to figure out what's the right choice for me."

"Medical decision-making is rarely black-and-white," adds the NIH's heart chief Dr. Elizabeth Nabel. "We see certainly helping to provide additional evidence that really guides physicians and individuals in sorting through the shades of gray."

The bypass-versus-stent question for severe heart disease is a good example. Last week's New England Journal of Medicine published a comparison suggesting bypass recipients fare slightly better. But Nabel notes that in fact the study found tradeoffs that mean people may legitimately choose the easier recovery of a stent.

A bigger question is how to ensure that patients get the opportunity to consider such findings. AHRQ has begun translating its jargon-filled comparisons into easy-to-understand consumer brochures.

But the most-used comparative effectiveness research may come from a unique program in Oregon called the "Drug Effectiveness Review Project" that evaluates the evidence behind competing drugs.

One example: Two years before the painkiller Vioxx was pulled off the market because of heart side effects, the project declared it riskier than its equally effective cousins, says project director Mark Gibson at Oregon Health and Science University.

The reports don't weigh drug costs but they are used primarily by the Medicaid directors of 14 states in coverage decisions. A wider audience sees them thanks to the influential Consumers Union, which does add price to evaluations done by both the Oregon project and AHRQ to create its free Web-based "Best Buy Drugs" guides.
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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On the Net:
AHRQ: http://effectivehealthcare.ahrq.gov
Oregon project: http://www.ohsu.edu/drugeffectiveness/

Copyright © 2009 The Associated Press.

High Cost and Waste: US Health Care System

The concept that health care in the US is costly and wasteful is a decades old evaluation of the system. Over the 40 years I have been involved in mainstream medicine I have heard this argument and discussion more times than you would like to know. Yet little has changed. And I am not too sure the stimulus health plan will much of anything to increase quality, increase access or reduce costs.

It is an odd thing to think that back in the first few years of the 1970s when I started grad school and undertook a program leading me to the nurse practitioner arena, the reason I went in this direction was to increase patient education, improve access to care and focus on prevention.

Now here is the same discussion four decades later: American College of Physicians Issues New Policy on Nurse Practitioners in Primary Care

Why are we having the same discussion? I knew 40 plus years ago what my role was and so did the physicians I worked with (not under). When I was teaching this discipline I knew and so did my students. We were a pretty independent bunch and we practiced in and independent way.

These days it is much more controlled, but the costs aren't the result of tort lawyers.

Drugs are it, labs tests are us, and layer upon layer of bureaucracy at the insurers requires an entire staff of people who do nothing but billing.

Where is that universal claim form we were told we'd see, that would keep costs down?

Oh, yes, I've heard the electronic records story before too. I guess there isn't much I haven't heard.

So why is it that only 80% of health care isn't working after all this time?

Maybe the reason why I switched to natural health care only.

US health system is plagued by high cost and waste: experts
by Jim Mannion

WASHINGTON (AFP) – The United States has one of the world's most advanced but also most complicated health care systems, plagued by widespread waste and costs that have escalated as the US population ages, experts say.

Venturing where others have failed, President Barack Obama is now proposing to spend 634 billion dollars on reforms aimed at expanding health care coverage among the nearly 46 million uninsured Americans.

How he should do it -- and whether it should be done at all -- are likely to be the subject of fierce debate. But, in the words of one economist, the system he inherits is "an administrative monstrosity."

Economist Henry Aaron, in a 2003 paper, called it "a truly bizarre melange of thousands of payers with payment systems that differ for no socially beneficial reason, as well as staggeringly complex public systems with mind-boggling administered prices and other rules expressing distinctions that can only be regarded as weird."

Following are some aspects of the system revealed in a review of the scientific literature by the Rand Corp., a non-partisan think tank, and posted on the website www.randcompare.org.

First, Americans are living longer but two of every three are overweight or obese, one in 10 have diabetes, and about a quarter of the population between the ages of 45 and 54 suffer from hypertension.

More than half are covered by insurance provided by their employers, but it is not required and the quality of coverage varies widely. Nearly 16 percent of Americans have no insurance at all.

Meanwhile, US spending on health care is growing faster than the economy as a whole.

It hit 2.1 trillion dollars in 2006 and was projected to reach 2.25 trillion dollars by 2007, an annual increase of 6.7 percent, according to the Centers for Medicare and Medicaid Services. It could reach 4.3 trillion dollars a year in a decade.

"By 2017, about 20 cents of every dollar spent in the US economy will be spent on health care," Rand said.

The federal government in 2006 covered about a third of US healthcare spending, mainly through its health insurance programs for the poor and elderly -- Medicaid and Medicare.

Payments by private insurances companies accounted for another 34 percent, while out-of-pocket payments by individuals amounted to 14 percent of the total. The remainder came from state and local funds and other private funds.

On average, Americans spend about six percent of their after-tax income on health care, although in the case of the poor or elderly the share is larger.

Among the trends driving up health care spending, the Rand survey found, are lengthening life spans, the spread of obesity, and technological innovations that push back mortality but at a higher cost.

Technological advances alone account for over half the increase in overall US health spending, according to an estimate by the Congressional Budget Office.

"Certain technological changes, for example some vaccines, may reduce spending. However, in general new technologies tend to increase the number of health services that an individual receives, thereby increasing costs," Rand said.

At the same time, the US system is seen as wasteful compared to those of other countries.

The United States spends significantly more on administrative costs than countries with single payer systems -- seven percent compared to 1.9 percent for France, for example, according to the Organization for Economic Cooperation and Development.

And private insurance companies have higher administrative costs (14 percent) than public insurance programs like Medicare or Medicaid, which come in at three to five percent of the total, the literature shows.

"Practitioners and hospitals, in their interactions with multiple payers, are encumbered by numerous billing requirements, a multitude of formulars and clinical care guidelines, and patients with different covered benefits," Rand said.

Studies also have shown that one-third or more procedures performed in the United States were of questionable benefit, according to the think tank.

A 2008 study that compared health care systems in developed countries found that US patients reported waiting less time to get an appointment to see a specialist, but also more problems with the cost of the care and the efficacy of procedures.

Within the United States, however, patients covered by Medicare consistently gave higher marks for the care they received than did those insured by private companies, according to surveys funded by the Agency for Healthcare Research and Quality.

Copyright © 2009 Agence France Presse. All rights reserved.