“Quality and Me Can Save You a Bundle!”

“Waste in the U.S. health care system ranges from $760 billion to $935 billion per year, or more than total annual federal defense spending, according to a new study.”  For my money, the U.S. military is too big, way too expensive, and should be pruned back.  Yet all of that wasted money is expended under the permission of the original U.S. Constitution, the one that makes defense a federal responsibility and says not one, damn thing about health care.

“Administrative activities account for the largest source of needless spending, followed by inflated and opaque pricing.”  A critical reason for the federal government’s inability to effectively manage health care (and education, and housing, and retirement, and etc., etc.) is that there is no philosophical foundation for this activity.  The federal government, as embodied by its politicians and bureaucrats, values power, and results are at best incidental to maintaining and expanding that power. 

“Activities such as medical coding and billing, recordkeeping and other clerical activities result in roughly $266 billion in excess spending annually, according to the study, which was published this week in the Journal of the American Medical Association.”  Well, they ought to know.  The Vichy AMA has been the eager handmaiden for the government perversion and enslavement of medicine for over a half-century.  “Factoring in other inefficiencies, such as a lack of price controls for health services, poor coordination of care, and fraud and abuse, the total tab that is wasted every year runs between $760 billion and $935 billion, according to the researchers. That’s fully a quarter of all annual health care spending in the U.S.”  Add to that the over-utilization of patients across all demographics, the inefficiencies of a thoroughly corrupt Big Insurance, and the joys of defensive medicine.

“Indeed, a 2016 study funded by the American Medical Association found that doctors spent almost twice as much time on administrative work (49% of their time) as they did seeing patients (27%). Physicians also took another one to two hours of clerical work home with them each night.”  While helping to build such a glittering, punitive mess, the AMA might have noted two obvious points of our system:  (1) Patients for all their empty talk, do not trust doctors, and have empowered their third-party surrogates to control them; (2) patients and their surrogates do not want to pay their doctors a nickel more than they have to.  It is not quality of care, nor compassion that is the basis for all of this meaningless work, but mistrust and greed. 

“The existing fee-for-service payment system, under which each provider bills for the services they deliver, is another major source of complexity and waste (uh-oh, here it comes)…Moving to a value-based system could help reduce administrative costs, said the authors, physician William Shrank and public health expert Teresa Rogstad.”  Yeah, I thought that’s where we were going.  “The more we can make this whole process frictionless, seamless, simple for providers and patients and focus on what we really want to do — take care of patients — there is a real opportunity to do that and reduce waste at the same time,” Shrank said.” 

I fed that through the universal translator, and it came out in a high-pitched robotic voice:  “Promise more to patients and pay doctors less.”  “Computer!,” I yelled, “Who exactly IS Dr. William Shrank who is giving me such good advice, and who cares so much??” (And yes, that is actually his corporate caricature)

But it was only a universal translator, and shut down because I yelled at it.  But the internet told me that William Shrank, MD became Humana’s new Chief Medical Officer in April, and before that was the University of Pittsburgh Medical Center Chief Medical Officer, Insurance Services Division. There he “oversaw approximately $9 billion in annual health care expenditures for approximately 3.5 million members in Medicare, Medicaid, behavioral health, Managed Long Term Social Supports and commercial lines of business. He also developed and evaluated population health programs to further advance the medical center’s mission as an integrated delivery and financing system.” 

But wait, there’s more!  Shrank was Senior Vice President, Chief Scientific Officer, and Chief Medical Officer of Provider Innovation at CVS Health, after he was “Director, Research and Rapid-Cycle Evaluation Group, for the Center for Medicare and Medicaid Innovation, part of the Centers for Medicare and Medicaid Services (CMS), where he led the evaluation of all payment and health system delivery reform programs and developed the rapid-cycle strategy to promote continuous quality improvement.”  Before that, he began “his career as a practicing physician with Brigham and Women’s Hospital in Boston and an Assistant Professor at Harvard Medical School. His research at Harvard focused on improving the quality of prescribing and the use of chronic medications. He has published more than 200 papers on these topics.”  How refreshing to see yet another Ivory Tower type who figured out early how hard it is to see real patients, smoothly transition from academia to government to Big Insurance, the better to hand down more non-solutions to the little people while his security is long since assured. 

 Other health dollars wasters cited:

–       Inflated, opaque pricing of medical services, drugs and medical devices

–       Failure of care delivery

–       Failure of care coordination

–       Overtreatment or low-value care 

“The solution? Rewarding caregivers for delivering better care — not just more services — would certainly help. Ultimately, the goal is to align incentives for doctors, patients and insurance companies.”  More succinctly, this means of course, “pay doctors less.”

“If we pay doctors for the right outcomes, it addresses many of the key domains of waste that we outline in the paper,” said Lord Shrank.  “The vision is that insurance companies instead pay providers based on the outcomes they produce and the quality of care they deliver. In fact, they are rewarded when they produce the highest quality of care at the lowest cost.”  Rather than being a forward, innovative thinker, Lord Shrank shows himself to be a well-heeled parrot, repeating the same obviously faulty garbage that academia, Big Insurance, and the government keep pushing, based on the notion that doctors can control patient behavior.  This duplicitous article winds up with this gem: “Under the current system, it’s in the interest of health providers, hospitals, drugmakers and medical device makers to prioritize quantity, not quality, of care.”  No, “providers” are actually incentivized to prioritize quantity to make up on volume the losses inflicted upon them by third-party payers.  Under a “quality” system, these same parties whose interests are promoted by the likes of Lord Shank will remove even more control from “health providers,” and not incidentally, more of their dwindling income. 

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  6 comments for ““Quality and Me Can Save You a Bundle!”

  1. Kurt
    October 31, 2019 at 9:33 pm

    I say BullS#!t. Incentivize the patients to practice good health behaviors!!!! I can scream until I’m blue in the face for some of these morons in a rural area to change their lifestyles but they continue eating shopping carts full of Aldi frozen pizzas. They want me to pull them out of the
    Effffing hole.
    Incentivize Doctors? I say again BullS#!t as I’ve been yelling at patients with deaf ears for years. I do geriatrics and my latest mortality figures are s#!t. Well guess what? Most of my folks have pre-terminal and terminal illnesses. So giving them a good death (including my wife) is a bad thing? G-da#n them ivory tower bastids to Hades.

  2. JRDO
    October 27, 2019 at 6:18 pm

    One man’s waste is another man’s livelihood.

  3. Steve O'
    October 27, 2019 at 12:48 pm

    We are in the Iron Coffin of bureaucracy. Reform means it worsens. It is inexorable. There is no way out. Max Weber was an optimist. Whatever is unsustainable, ends.

  4. Rando
    October 26, 2019 at 9:29 am

    Every value-based or outcome-based “solution” I’ve seen increases paperwork, not lessens it.

  5. Thomas David Guastavino
    October 26, 2019 at 8:26 am

    I have said it before and I will say it again. If we physicians do not unionize we are going to have our clocks cleaned.

    • Sir Lance-a-lot
      October 28, 2019 at 5:49 am

      Amen, Brother.

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