A return to those boring times of yesteryear, when three people read my commentary on health research, policy and business.
Geographic variation in health spending in the United States has a long research history, with people puzzling over why it exists and what might address it. This research in Health Affairs (stacked up in my pile from early in the epidemic) finds that in regard to Medicare spending per beneficiary, the variation between regions actually declined in the decade from 2007 to 2017. During this period the difference between the top 10% spending regions and the lowest 10% spending regions declined by 14%. The previous fastest spending growth regions became the slowest ones, and vice versa, suggesting some regression to the mean. More use of post-acute care providers appeared to help reduce the variation. (HA Article)
This is yet another piece of research that indicates how much hospital outpatient clinics mark up the cost of infused specialty drugs, for no reason other than making a huge profit. It comes from the Blue Cross plans and finds that prices paid for those drugs in an outpatient department were twice as high as if the same drug were given in a physicians office. Across the country this practice leads to billions of dollars in extra spending a year, which could be simply remedied at least in Medicare and Medicaid by refusing to pay a different amount depending on the infustion setting. The authors worry about the impact on patient cost-sharing, but a properly designed reimbursement method would actually reduce patient spending as well as payer costs. (HA Article)
And from the government really is stupid department, Medicare is constantly trying to adjust reimbursement rules to prevent provider game-playing to maximize payments, but usually does so in a manner that only opens a new route for providers to try to get paid more. This study looked at the rule change that required that for inpatient payment, a patient had to be in the hospital for at least two midnights. Any other stay would be reimbursed at a lower “observation” stay level, and a hospital had to “guess” in advance which one a particular patient would be. It imposes an administrative cost on a hospital to decide which level a stay is. There was a pretty quick shift of a small percent of stays from inpatient to observation, but that leveled off. And it isn’t clear that total spending was any lower, or that the rule substantially changed a trend that was taking place anyway. And one way or another consumers and taxpayers pick up the added administrative cost of attempting to comply with the new policy. (HA Article)
As a retired MD I can tell you where monster savings could easily be had. Walk through an emergency area for a few hours. How many “true” emergencies are seen? My total guess is that maybe 40% of patients who go to the ER are appropriately there. The others get seen for their runny noses, ear infections, bladder infections, STD, wrenched back, minor lacerations, etc.
Yet everywhere I have been the practice of being a walk-in clinic PLUS an ER is the rule. So 60% of these people are charged emergency charges and the hospital wins. Most every other (I hate this word) stakeholder comes out worse, including the paying government program, the paying insurance company, and the really sick people who need to be seen now.
A very simple change would make everything work better, faster and less expensively: Convert some space in or adjacent to the ER and assign a triage type physician to do a quick, sometimes instantaneous, decision on each arriving patient. There would be quick admittance for those emergency cases that need full tilt emergency care. So no one gets into the ER until an easy and fast assessment is made.
The others (my assumed 60% of all patients who show up at an ER, yet who are not in need of emergency care) would be seen and cared for appropriately and as if the converted space was an outpatient office staffed by ER or family practice doctors. I believe tons of money would be saved. Alas, the hospitals would need to be brought kicking and screaming into the new order. It would save money for insurers and patients; hospitals’ revenue would fall. That’s the best part of it, other than every patient receiving the care he deserves in the medical setting that is appropriate to his condition.
completely agree with your assessment and another approach would be to just stop paying more for “emergency” services. it really doesn’t cost a hospital or any other operator of ERs more and they all now see it as a profit center.