Morning Joe, Medicare's chief actuary estimates 15-30% of health care expenditures are wasteful.

[flpoljunkie]

(This is where you start. This, and allowing the members of President Obama's Medicare Independent Payment Advisory Board to be appointed and do their job.)

Experts defend Medicare board
By: Sarah Kliff
May 25, 2011 05:00 AM EDT

The much-maligned Independent Payment Advisory Board finally has some champions.

One hundred health policy experts and economists sent a letter, obtained by POLITICO, to congressional leaders early this week urging legislators to back off their many attempts to repeal the health reform provision.

“We believe that an independent board is essential to promote, monitor and implement reforms that improve Medicare and the nation’s health care system,” they wrote.

The signers include notable centrist health economists, including Alice Rivlin of the Brookings Institution, along with many liberal health policy scholars.

http://www.politico.com/news/stories/0511/55622.html

Excerpt from: Squandering Medicare's Money

The full extent of Medicare payments for procedures with no known benefit needs to be quantified. But the estimates are substantial. The chief actuary for Medicare estimates that 15 percent to 30 percent of health care expenditures are wasteful. Medicare spending exceeded $500 billion in 2010, suggesting that $75 billion to $150 billion could be cut without reducing needed services.

Why does Medicare spend so much for procedures and devices on patients who get no benefit and incur risks from them?

One reason is that Medicare’s reimbursement procedures are not sophisticated enough to track the appropriateness of the care provided. Medicare delegates its claims administration to private local contractors based on how quickly and cheaply they can process claims.

These contractors have few incentives to audit the taxpayer dollars they are paying out, and even if they wanted to, they would need information often not available on the claim form. For example, a claims administrator, processing a claim for a screening colonoscopy, does not know when the patient’s last colonoscopy was, or whether there was a new clinical reason for repeating it. While this information is available, finding it would require extra steps, and there are no incentives to do so.

more...

http://www.nytimes.com/2011/05/26/opinion/26redberg.html?ref=opinion&pagewanted=print

[no_hypocrisy]

1. While some of the tests may be subject for review *,

I'm certain there's a certain amount of fraud involved.


* I fell on my arm, got x-rays of the upper arm yesterday but the prescription included x-ray of my shoulder which was unharmed and not near where I fell. I understand the concept is to rule out any possibility of any injury, but that's at least 3 x-ray shots too many and billing for them. In medicine, physicians have routine tests for patients more to rule out possible problems rather than to confirm a diagnosis.

[tularetom]

2. Shouldn't be confused with the overhead that Medicare actually incurs

I've seen statistics to the effect that Medicare operates on something like 3% administrative costs, an impressive number when contrasted with the 30% plus that most private insurance plans take off the top.

Perhaps if that figure was bumped up to 4 or 5% there could be more oversight provided to weed out waste fraud and abuse and get rid of unneeded medical procedures.

[bullimiami]

3. I think its safe to assume that healthcare overall is not wildly different than medicare.

If they have 30% administrative costs instead of 3% and
15 - 30% of procedures are waste, fraud, abuse or excessive.

The private healthcare industry is skimming as much as 57%.

Yet the republicans repeatedly target medicare and seek to further deregulate private healthcare.
Its obvious that this is not about saving money or fixing a broken system.
Its about class warfare.

[randr]

4. Medicare at least has a system in place that could bring down costs

and get a handle on fraud and overpricing.
When the Insurance and Pharmaceutical industries are in collusion to buy congress and set prices we all need to worry.

[Mojorabbit]

5. The headlines for fraud seem to deal with

equipment it seems. I don't think turning medicare into a program like an HMO where bean counters second guess if a patient needs a colonoscopy or not is necessarily a great idea.

[LiberalFighter]

6. There needs to be a procedure that encourages doctors to do the right thing.

Maybe requiring that regardless of any paperwork a patient signs the doctor/hospital will have to pay 50% of the cost of that procedure if it is ruled inappropriate.

Also, they need to update their forms so Medicare has the necessary info to determine whether it is appropriate.

Are they saying that Medicare doesn't have the same information that insurance companies have? I find that hard to believe. Even Medicare has deductibles and it requires keeping track of what is covered and how many times it is covered.

[nichomachus]

7. A recent example

I had lab orders from two doctors. They were for the exact same tests. I went to the lab and they drew two identical sets of blood samples. I asked why they couldn't simply do one set of tests and send copies of the results to each doctor. They said they couldn't do that. So Medicare paid for duplicate and unnecessary tests.