Around a quarter of healthcare spending in the US is wasted, much of it on unnecessary or low-value tests and procedures that do not improve patient outcomes. So what can be done about it? Here are some ideas:
The above measures and policies are just a sampling of what’s possible.
Cost containment measures often do double-duty: save money and improve patient outcomes. And that includes prior authorization, which has gotten a lot of bad press lately. Prior authorization saves lives to the extent that it leads to fewer adverse events from unnecessary care. Unfortunately, unnecessary care and adverse events are commonplace in the US. According to a recent government study, twenty-five percent of Medicare patients experienced patient harm during their hospital stays during a one-month period in 2018. Patient harm included adverse events such as permanent disability, chronic pain, and death. Physician-reviewers determined that 45% percent of the adverse events could have been prevented if patients had been provided better care. No wonder Medicare has increased its use of prior authorization.
Now consider that the American Society of Anesthesiologists estimates 20–40% of back surgeries fail. Failure rates vary depending on the type of surgery and the number of surgeries a patient has had:
Lumbar fusion: The failure rate for lumbar fusion is 30–46%.
Microdiscectomy: The failure rate for microdiscectomy is 19–25%.
Repeat surgeries: The success rate for a second back surgery is 30%, and decreases to 15% for a third surgery and 5% for a fourth.
If spine surgeons didn’t get pushback from insurance companies, more Americans would get back surgeries and a good number of them would suffer the consequences.
References:
Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018. U.S. Department of Health and Human Services, Office of Inspector General, Report in Brief. May 2022, OEI-06-18-00400. https://oig.hhs.gov/reports/all/2022/adverse-events-in-hospitals-a-quarter-of-medicare-patients-experienced-harm-in-october-2018/
Alhaug, Ole Kristian et al. Predictors for failure after surgery for lumbar spinal stenosis: a prospective observational study The Spine Journal, Volume 23, Issue 2, 261 – 270. DOI: 10.1016/j.spinee.2022.10.010 February 2023
Gusmano, Michael K., Miriam Laugesen, Victor G. Rodwin, and Lawrence D. Brown. "Getting The Price Right: How Some Countries Control Spending In A Fee-For-Service System: Study examines mechanisms commonly used by some countries to set and update health care prices." Health Affairs 39, no. 11 (2020): 1867-1874. https://doi.org/10.1377/hlthaff.2019.01804
Moreno-Serra, Rodrigo. "The impact of cost-containment policies on health expenditure: evidence from recent OECD experiences." OECD Journal on Budgeting 13, no. 3 (2014): 1-29. https://doi.org/10.1787/budget-13-5jxx2wl6lp9p
Orhurhu VJ, Chu R, Gill J. Failed Back Surgery Syndrome. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539777/
Links:
https://www.ncsl.org/health/bulk-purchasing-of-prescription-drugs
https://www.gao.gov/assets/gao-18-341.pdf
https://leadboldly.kaiserpermanente.org/reduc-operating-costs/