Where is money wasted in healthcare?

nerdtonurse?, BSN, RN · Jul 1, 2009

You want to save money in health care? Make it a rule that unless a person has a real immediately life threatening medical condition (trauma, GI bleed, something demonstrable), if they come into the ER positive for illegal drugs, they are NOT admitted. Send them to a rehab, but DON'T ADMIT ADDICTS. If they want to get clean, that's great, and we'll move heaven and earth to help. But if they just want to get narcotics because they've run out of money before they've run out of month, or because they're hiding from the pusher they can't pay (and that's a fun night, cops all over the unit), they do NOT belong in a hospital.

If the facility can do it, have a 24/7 outpatient clinic -- the folks that come in with a cold at 2 am go to the clinic, not the ER. Keep the ER for what it's designed for, which is not primary care, but for emergencies.

vivacious1healer · Jul 1, 2009

CEOs making 7 figure salaries......

Managers and directors making 6 figure salaries.....

These people are NOT saving lives or saving $$$ at our hospital, yet the administration deems it fit to cut costs in nursing and ancillary care, AND demand that we do more to improve patient satisfaction scores!

Go figure!:angryfire

llg, PhD, RN · Jul 1, 2009

1. Duplicate paperwork ... overlapping committee responsibilities ...etc. as each agency and 3rd party payor sets its own specific requirements that must be met. That leads to poor coordination and inefficiency at every step in the process.

2. "Penny-wise, pound foolish" thinking among administrators who "save money" by cutting ancillary staff -- thus dumping their work onto higher paid RN's -- who then struggle to provide high quality care -- which results in major financial loss through expensive errors, inefficiency in patient flow, etc. as well as in increased VERY expensive staff turnover. Other "cost-cutting" measures often have the same effect of saving a little money up front, but causing big expense down the road. If the focus were on quality and "doing things right the first time," it might cost a little more up front but save money in the long. But such thinking is often not allowed because of the up front costs.

3. End of life care -- Way, way too much money is spent on patient who only have a very short time to live. Rather than enroll grandma or grandpa in a comapssionate hospice program, they are placed in an expensive ICU where they are subjected to many expensive tests and procedures -- when everyone with any common sense knows they are going to die anyway within days or weeks. Hospitals should be set up so that such patients are guided toward cheaper hospice care instead -- but short-sited hospitals see those patients as revenue generating and encourage such expense, not seeing that it is bankrupting the entire system of health care, which is bad for everyone in the long run.

yesdog, BSN, RN · Jul 1, 2009

enroll grandma or grandpa in a compassionate hospice program

EXACTLY!!!! :yeah: :yeah: :yeah:

ShayRN · Jul 1, 2009

I agree on the ICU stays. It is CRAZY to me that people are left on vents/tube feeds/hyperal for long periods of times. I don't want my mom to die either, but there is a VERY big difference between living and existing. Lying in a bed isn't living IMHO.

Katnip, RN · Jul 1, 2009

I agree with the time it takes to do redundant paperwork.

Enormous numbers of dollars are spent on futile care because a family member doesn't want to let go. Hospital admins need to grow a pair and say we've done all we can, try to sue us. I recently saw a case in New England somewhere where a family sued because the hospital refused to override a patient's advance directive. Judge wouldn't even look at the case saying the advance directive was a legitimate, legal document and they had no right to override it. We need to see more of that.

And speaking of lawsuits...they need to stop or drastically cut back. Greedy lawyers go after scared, grieving or greedy families. Yes, there are some cases of malpractice or negligence where compensation should be awarded. But things go too far. Even if a hospital or other defendent wins, it can cost a huge amoount of money and time to defend the case.

Also the quick readiness to sue leads to more and more unecessary tests so doctors can cover themselves.

Spending money on cosmetic items rather than patient care. Will that grand piano in the lobby actually help a patient get well? How about the marble tiles, the original paintings, etc? Put money where it can help.

Seagate · Jul 1, 2009

kits.

a lot of the kits used for various procedures cost $300-$1,000 and up.

yesdog, BSN, RN · Jul 1, 2009

I heard an excellent lecture regarding palliative care in the ICU. The lecturer made the point "We don't ask the family if we should give Vasopressor or not, why do we ask them if we should give CPR or not?"

StNeotser, ASN, RN · Jul 1, 2009

I work in a rehab medicare unit. I can't tell you the amount of inappropriate people we get for "rehab" who are 90+ years of age whose families think that Mom or Dad will get better and be able to go back to Assisted Living or home. We have a lot of full code people who we have no resources for should we actually have a code.

I can tell a hundred or so such stories where thousands of dollars were spent on for want of a better word, a lost cause. I am not saying that our older generation don't deserve the very best possible care, but palliative care would be far better for so many patients than long ICU stays and surgeries they have no chance of recovering from.

thinkertdm · Jul 1, 2009

I agree on the ICU stays. It is CRAZY to me that people are left on vents/tube feeds/hyperal for long periods of times. I don't want my mom to die either, but there is a VERY big difference between living and existing. Lying in a bed isn't living IMHO.

Concentration camp survivors existed. Would you have preferred them all to have died? Are you going to decide who is "living" and who is "existing"? How about a 32 year old who works 3 jobs and no time to pay the bills? Are they living? Or just existing? Hell, most people are just existing!

ShayRN · Jul 1, 2009

Concentration camp survivors existed. Would you have preferred them all to have died?
Your comparing apples to oranges and I am offended you would compare my words with what I consider one of the worst things done to a human. What was done to the Jews in Nazi German was pure evil. Letting nature take its course with a 95 year old who is dying isn't.