A new report from a panel of experts convened by the Institute of Medicine estimated that roughly 30 percent of health care spending in 2009 — around $750 billion — was wasted on unnecessary or poorly delivered services and other needless costs. Lack of coordination at every point in the health care system is a big culprit. The panel cited studies showing that 20 percent of patients reported test results or medical records that were not transferred from one place to another in time for an appointment, requiring additional tests or visits.
One study found that a typical Medicare patient with Type 2 diabetes (without other medical conditions) saw five different doctors in a year. Another showed that the rate at which primary doctors referred patients to specialists doubled over the past decade. In one survey, primary care doctors who had Medicare patients coordinated with an average of 229 other physicians in a single year to care for those Medicare patients, blurring accountability.
No wonder another survey found that 75 percent of hospital patients were unable to identify the clinician in charge of their care. Almost two-thirds of patients don’t know how much their care costs until they receive a bill, and less than half receive clear information on the benefits and trade-offs before undergoing treatments. Worse, the extra spending did not help patients. In fact, one study found that one-third of hospitalized patients are harmed during their stay, driving up their medical costs.
The panel concluded that there is no single answer for reducing inefficiencies. Instead, it said that every participant in the system — doctors, hospitals, big integrated health care systems, insurance companies and government agencies — had to expand ways to provide usable information when doctors and patients decide on treatments, engage patients in clinical decisions, and adopt technology-assisted practices that have improved reliability and cut costs in other industries.
What’s clear from this report is that the pilot projects in the Affordable Care Act to encourage better coordination of care, make medical prices transparent and accelerate the use of health information technology are only a modest start. These have to be expanded, not repealed, if the nation hopes to make a real dent in health care costs.