NLM Director’s Comments Transcript
Cutting Health Costs: 06/18/2012

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Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

Medicare’s former chief proposes six areas to cut U.S. health care costs — and argues savings from cutting waste are preferable to lowering payments and reducing medical services, in a sweeping analysis recently published in the Journal of the American Medical Association.
Donald Berwick M.D., who was Medicare’s and Medicaid’s administrator until late last year, and Andrew D. Hackbarth, RAND Corporation, write and we quote: “The opportunity for waste reduction in health care is enormous’ (end of quote).
While Berwick and Hackbarth agree increases in current health care costs are unsustainable (and expected to rise from 18 to 20 percent of the U.S. gross domestic product in the next eight years), they argue cutting costs by eliminating waste is a more socially responsible and viable option than reducing access to clinical services, or reducing the reimbursements physicians receive to provide health care.
Berwick and Hackbarth add quickly implemented or extensive reductions in reimbursements for health care services pose a social risk. They write (and we quote): ‘Vulnerable Medicare beneficiaries and seniors covered by Medicare with marginal incomes may find important care services out of reach, either because they cannot afford the new cost-sharing, because clinicians and hospitals have withdrawn from local markets, or both’ (end of quote).
Instead, Berwick and Hackbarth propose cost savings by eliminating waste in six key areas of the health care delivery system.
These include: failures of health care delivery, poor care coordination, overtreatment, reducing administrative complexity, pricing inconsistencies, and cutting medical fraud and abuse.
For example, Berwick and Hackbarth estimate $102 to $154 billion could be saved each year by a more widespread adoption of health care best practices. They add the expensive impact of substandard evidence-based health care practices includes patient injures and poorer clinical outcomes.
Berwick and Hackbarth estimate $25 to $45 billion could be saved annually by enhancing clinical care coordination. They explain deficient care coordination results in hospital readmissions, declines in the functional status of patients, and increased patient dependency on clinical services.
Berwick and Hackbarth estimate $158 to $226 billion could be saved annually by reducing medical overtreatment. They write (and we quote): ‘examples include excessive use of antibiotics, use of surgery when watchful waiting is better, and unwanted intensive care at the end of life for patients who prefer hospice and home care’ (end of quote).
Similarly, Berwick and Hackbarth suggest $107 to $389 billion could be saved by standardizing medical cost reimbursement forms, and reducing the current time physicians spend to bill for their services. The authors find these and other improvements in administrative complexity need to be better coordinated among government, insurance companies, and medical accreditation agencies.
The authors note $84 to $178 billion could be saved annually by more transparency and establishing internationally consistent prices for the same diagnostic procedures, such as an MRI or a CT scan. They add $82 to $272 billion could be saved annually by reducing scams and fake bills for medical services as well as reducing the inspection and regulatory costs that occur as a result of the misdeeds of relatively few health care providers.
Berwick and Hackbarth conclude (and we quote): ‘the opportunity (to reduce costs) is so enormous that achieving even a fraction of that amount in the short run could help health care turn the corner toward stability without harming patients’ (end of quote).
Incidentally, Berwick and Hackbarth’s cost savings estimates are grounded in recent research.
Turning now to MedlinePlus, a website about new tools to reduce Medicare fraud (from the U.S. Department of Health and Human Services) is available in the ‘law and policy’ section of MedlinePlus.gov’s Medicare health topic page.
The Centers for Medicare & Medicaid Services (that Dr. Berwick administered until December 2011) also provide an overview of Medicare fraud in the ‘law and policy section’ of MedlinePlus.gov’s Medicare health topic page. The Centers for Medicare & Medicaid Services add a guide to protect you from dishonest Medicare suppliers, which is available in the ‘related issues’ section.
MedlinePlus.gov’s Medicare health topic page additionally contains updated research summaries, which are available within the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the Medicare health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.
To find MedlinePlus.gov’s Medicare health topic page, type ‘Medicare’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Medicare (National Library of Medicine).’
MedlinePlus.gov also contains related health topic pages on: Medicare Prescription Drug Coverage, Medicaid, Health Insurance, Financial Assistance, and Managed Care.
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A disclaimer – the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider. I want to take the opportunity to wish you a very happy holiday season and a healthy New Year. The National Library of Medicine and the 'Director's Comments' podcast staff, including Dr. Lindberg, appreciate your interest and company – and we hope to find new ways to serve you in 2012.
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