Where is money wasted in healthcare?

[country mom]

Some time ago, I took a week-long class in a process called "Six Sigma", which began in industry and has now migrated over to health care. Officially, it is known as a "process improvement" effort, but long story short it's about cutting costs and saving money. The Six Sigma process was designed by engineers, so it takes months and months of measuring, graphing and data collection to get the end result. I'm a "cut to the chase" kinda girl, so would love to hear where other nurses are seeing wastefullneess in health care. Big things, small things, whatever.

[JustMe]

Statistically we (USA) spend far more on health care for the aged than any other group. The SSA website states that we spend 2.75 times more money on hospitalization for the aged than for those under 65. This stands to reason since the over 65 group tends to have more medical problems. But, as was posted earlier, I believe we torture those poor old folks when we admit them to the ICU and stick a tube in every hole and sedate them into oblivion. To what end?? American medicine has created some miracles, true. But miracles are few and far between and are very costly even if they do occur. I see a new trend among younger doctors that is reassuring. They seem to be more willing to tell families that we have reached the end of treatment for their loved ones. It is still a rare family that is willing to let grandma go peacefully instead of demanding that "everything" be done. Sadly, most people don't understand what that means. I hope my loved ones let me go so my health care allotment can be used to help kids grow up healthy.

Just my

http://www.ssa.gov/history/reports/65council/65part2.html

[thinkertdm]

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.

I would just like to ask who will be deciding who lives and who dies. The insurance company?

Also, I see SCI patients with a high cervical injury, all with a vent and no chance for recovery. These people are little more than heads, with no ability to move, and will ultimately cost far more than a 95 year old on a vent. Should they be "allowed to die"? Many other people are included in your "existing vs living" analogy.

Be offended all you want. Deciding who should live and who should die all to save money, comparatively meaningless bits of paper, is inhuman.

[stripbubbles]

The problem with waste in healthcare is so multifactorial. Lack of medical knowledge amongst the public, insurance companies looking for profit, overuse of services, end of life care, not enough focus on prevention and health promotion, lack of evidence based medicine........ The good news is that the industry and the government are finally engaging in a real debate about these issues. As nurses, we should also be talking about the future of health care. Personally, I feel that end of life care is a big one but I don't know what the alternative could be. Should there be some kind of litmus test put to patients before they end up in the

icu? We try very hard to honor peoples wishes, DNR/DNI, but often times family members will rescind them at the last moment. We need more research in this area. Maybe some kind of a score could be given based on statistics whether or not we should proceed with aggressive care. I'm not advocating reducing people to stats but I really don't know what else to do.

[PeachPie]

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.

That was a great response to the Godwin's Law occurrence!

Yes, I agree:

-Get rid of the aesthetics, especially the white elephants like fancy fountains that need to be de-mineralized.

-Staff adequately so you don't have to depend on overtime and agency.

-Make hospitals a place to receive healthcare, not a vacation getaway.

-Recognize futile care.

[thinkertdm]

Concentration camp survivors existed. Would you have preferred them all to have died?

I would just like to ask who will be deciding who lives and who dies. The insurance company?

Also, I see SCI patients with a high cervical injury, all with a vent and no chance for recovery. These people are little more than heads, with no ability to move, and will ultimately cost far more than a 95 year old on a vent. Should they be "allowed to die"? Many other people are included in your "existing vs living" analogy.

Be offended all you want. Deciding who should live and who should die all to save money, comparatively meaningless bits of paper, is inhuman.

Sorry- the real crux of my argument with you is your arbitrary decision of basing someones LIFE on whether they are "existing" vs "living". There are many ways to justify this "saving of money", and each one is as zany as the last. Should we select people who don't contribute to society? Should we pick people who are going to die anyway? Should we pick people who have serious diseases? Should we only pick the poor people?

Please don't fall into the thinking that money is more important than life itself. What benefits a person if they gain the world, but lose their soul? The money you save anyway will not go toward anything good; it will simply make rich people richer. Which doesn't include you or me.

[PostOpPrincess, BSN, RN]

Tests, tests, tests for someone with a hangnail (I am oversimplifying)-- all to appease the lawyers and their litigious clients......

[PostOpPrincess, BSN, RN]

Oh, and another thing....trying to keep Great, Great grandma alive because Grand and Great Grandma have issues with death and want to keep her around forever even though she is so septic that 17,000 mcgs of Levophed has her BP at 50 by doppler.

Sheesh.

[thinkertdm]

Concentration camp survivors existed. Would you have preferred them all to have died?

That was a great response to the Godwin's Law occurrence!

Yes, I agree:

-Get rid of the aesthetics, especially the white elephants like fancy fountains that need to be de-mineralized.

-Staff adequately so you don't have to depend on overtime and agency.

-Make hospitals a place to receive healthcare, not a vacation getaway.

-Recognize futile care.

My point is that it's all futile care. Their is no significant return on investment, as humans break and die, sooner or later.

Also, I wasn't referring to Hitler; I was referring to the fact that numerous people have been subject to conditions that reduced their humanity, yet their value as human beings never diminished. But when you have a choice of saving some amount of money, and letting a 23 year old spinal cord injury continue his life, suddenly the money saving is the focus.

[Katnip, RN]

Concentration camp survivors existed. Would you have preferred them all to have died?

I would just like to ask who will be deciding who lives and who dies. The insurance company?

Also, I see SCI patients with a high cervical injury, all with a vent and no chance for recovery. These people are little more than heads, with no ability to move, and will ultimately cost far more than a 95 year old on a vent. Should they be "allowed to die"? Many other people are included in your "existing vs living" analogy.

Be offended all you want. Deciding who should live and who should die all to save money, comparatively meaningless bits of paper, is inhuman.

Keeping someone artificially alive does the same thing. Going against a patient's advance directive because family wants it is the same.

[noladancer]

This is from personal experience, not nursing experience (I don't have any of that yet). Every time I have a primary care visit, my doctor's office submits the paperwork with the wrong code. The billing company then submits it with the wrong code, and the insurance company processes it incorrectly. I then get a bill when I shouldn't (I've already paid my co-pay for the visit), so I have to call the billing company, who has to contact the doctor's office and tell them to resubmit it under the correct code. I've complained and complained (and the billing company tells me I'm not the only one complaining, and it's not just my doctor doing this). I've left messages for the Office Manager at the doctor's office (it's a large practice with 10+ doctors) but hear nothing back. I have an appointment with my doctor next week for medical reasons and am going to say something to her at that time about her coding because everyone else is having to do their job twice! This may seem small but if you multiply this by how many times this happens every day across the country, it's an enormous amount of money being wasted.

[DolceVita, ADN, BSN, RN]

Very cool. I was a six sigma black belt before I left my previous profession.

[BrnEyedGirl, BSN, MSN, RN, APRN]

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.

And while we are at it,..Medicaid should never and I mean NEVER pay for a pregnancy test at 0200 when that is the only reason a pt checks in to the ER. Medicaid shouldn't pay for the visits when Mom brings in her 18 mo old who's had a fever of 102 for an hour, she didn't give Tylenol and "while your at it,..I want the doc to see my other three kids because when one gets sick they all get sick"!

If you have 37 ER visits in the last 90 days, with no emergent dx, you should be told to stop going to the ER! We shouldn't have to pay for that! I checked in a 20 yr old female,.at 0300 a couple of days ago,...here with her grown mother,...7wks pregnant,.."I can't feel the baby move, something must be wrong",....she waited 4hrs to be seen and our tax dollars paid for it,...talk about waste!

AARRGGHHHH,......people need to start taking some personal responsibility over their own health!