More ideas for addressing the Affordable Care Act…

In my last post, I recommended a series of ideas for reducing the costs of care. What we hear discussed in the daily media are legislative techniques for shifting costs to other parties- rarely do we see recommendations for actually reducing costs.

We have accepted the goal of “bending the cost curve”, which means slowing the rate of annual increase. This is not nearly enough. We must strive to actually reduce the costs of care, so that they begin to resemble costs in other large, diverse, developed countries. Presently we run about 30% higher than these other developed countries.

To put the costs of our health care system in perspective, our President’s recent military proposals have been estimated to cost $54 Billion, and this number is causing many to pause and wonder how we will pay for it. Guess what? Our health care industry spends $54 Billion every 6 days!

What follows are more recommendations for actually reducing costs, as a follow on to my last post:

Place limits on, or require justification for many commonly overprescribed tests which have not demonstrated real value. Among these are annual EKGs, many imaging tests including PET scans, annual PAP exams, some bone density tests, some colonoscopies and believe it or not, the annual physical. Source: AARP Bulletin, March 2014. (Read their full article to understand the limits of what they are saying).

Fraud and Financial Review
Conduct more frequent and more aggressive fraud audits. Invest in advanced technologies to assist in identifying fraud. The ROI on these investments is quite high.

Similarly, conduct more contract audits. These do not identify fraud as such, but cases of exorbitant pricing that may not technically be fraud.

Create and publish a national database of list prices for common procedures, by zip code. As recommended in my last post, providers should also be required to publish their list prices for common procedures and items.

Create a national network of urgent care centers that will provide a range of services at published prices and that will accept all certified plans. These centers should be able to interpret and read tests performed by others, and to prescribe and deliver follow-up care. The intent is to supplement the network of HRSA funded Community Health Centers already in place.

End of Life Care
Allow and encourage advance planning and advance directives.

Remove the requirement for “doctor’s orders” to purchase most supplies (not drugs) that are non-invasive and do not expose the patient to radiation or toxic elements.

Eliminate provider markups and/ or stocking charges in excess of 5-10% for inventoried drugs, supplies, and items ordered directly for the patient, e.g. crutches.

It will be difficult to link these recommendations directly to a budget line item. This is why legislators do not come up with these types of suggestions. But with higher and higher deductibles, these are the types of recommendations that will translate directly into patient savings.

Remember- it is providing health care that is the privilege, and receiving it that is the right.

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