Thursday, January 14, 2010

Fraud, Abuse, Waste - Medinnovationblog Joins Waste-Not Movement

Medinnovationblog has joined the “Waste Not” blogger movement. My blog , I’ve decided, is a terrible thing to waste on my small audience of 12,000 to so. Other bloggers – such as The Health Care Blog and KevinMedblog – are now reprinting some of my 1164 blogs, before much larger blogger audiences.

Not New

The “Waste Not” movement isn’t new.

Euripedes (c. 485 – c. 430 BC) started it by declaring “Waste not fresh tears over old griefs.”

Over the past 40 years, the municipal waste industry has proclaimed we shouldn’t let waste go to waste. Instead we should convert waste to beneficial ecologically friendly products. The recycling industry even has a website.

The United Negro College Fund picked the waste-not theme up with its 1972 advertising slogan, “A mind is a terrible thing to waste.”

Not to be outdone, Rahm Emanuel, Obama’s chief of staff, helped persuade the President to launch massive federal financial stimulus programs, takeover over of the automobile and financial and energy industries, and overhaul of health care, by saying, “You never want a serious crisis to go to waste.” Perhaps Emanuel borrowed the idea from Paul Romer, a Stanford economist, who observed, “A crisis is a terrible thing to waste.”

Unfortunately, for Obama, if you judge by Presidential approval polls, which have dropped his approval ratings from 70 percent to less than 50 percent, over the last year, the public considers excessive government spending as waste. Government haste, in other words, makes for waste. Too much money, too much waste, too soon.

By far the biggest “Waste-Not” news in recent years has been highlighting waste in the health care industry.

In 2006 The Dartmouth Atlas of Health Care, after studying Medicare data, concluded one third of U.S. Medicare expenditures, roughly $700 billion, was “waste,” due overuse of resources in certain parts of the country, with one-third more spent in some Medicare regions than others. Dartmouth concludes we can stamp out waste by stamping out regional variations.

In October 2009, the Thomson- Reuters company, an international communications conglomerate, detailed this health waste in a white paper.

Here are some of the study's key findings:

Unnecessary Care (40% of health care waste): Unwarranted treatment, such as the over-use of antibiotics and the use of diagnostic lab tests to protect against malpractice exposure, accounts for $250 billion to $325 billion in annual healthcare spending.

• Fraud (19% of health care waste)
: Healthcare fraud costs $125 billion to $175 billion each year, manifesting itself in everything from fraudulent Medicare claims to kickbacks for referrals for unnecessary services.

Administrative Inefficiency (17% of health care waste): The large volume of redundant paperwork in the U.S healthcare system accounts for $100 billion to $150 billion in spending annually.

• Health Care Provider Errors (12% of health care waste
): Medical mistakes account for $75 billion to $100 billion in unnecessary spending each year.

• Preventable Conditions (6% of health care waste)
: About $25 billion to $50 billion is spent annually on hospitalizations to address conditions such as uncontrolled diabetes, which are much less costly to treat when individuals receive timely access to outpatient care.

• Lack of Care Coordination
(6% of health care waste): Inefficient communication between providers, including lack of access to medical records when specialists intervene, leads to duplication of tests and inappropriate treatments that cost $25 billion to $50 billion annually.

Presumably, all-knowing, efficient,and effective government, an oxymoron, can stamp out health care waste. Government, unfortunately, has little clue at what occurs at the medical marketplace level or at the edges of the patient-physician relationships, or that one doctor’s waste may be one patient’s hope.

There are many and various and sundry things that are terrible to waste,

Small blogs, lost causes, crises, minds, garbage, health care misplaced,

But when big government wastes untold trillions,

To pay off Senators and to cover all civilians.

That’s not waste - even when the federal deficit becomes a basket case.


Steve said...

There is another contributing factor to the "waste" in health care today not addressed in your post. I am speaking of the sub-optimal state of physician-patient communications in the U.S. Since the late 1970's, researchers have written about the deleterious effects of biomedical-dominated communication style on patient adherence, trust and outcomes. If physicians and patients could do a better job "communicating" with one another many of the other problems cited in your post would resolve themselves.

Steve Wilkins

Richard L. Reece, MD said...


You are mostly right. Doctors don't do a good job communicating with doctors and vice versa. But I would argue, there is not a complete vacuum. Physician websites containing patient education information and platforms for interactive exchange are growing. And the Health 2.0 movement, featuring electronic patient empowerment is in full swing. Patient-doctor email exchanges are on the rise. And there are websites, like, which allow patients to share their complaints, history, and demographics before visiting the doctor. Also many doctors are now engaging in remote monitoring of patients once they are out of the office, at home, or at work.

danaelliottMD said...

It is interesting to hear about this waste-not movement.

We are trying to also come up with a waste-not solution to help improve survival rates from sudden cardiac arrests, by coming up with a connecting tool between victims and rescuers. Too many opportunities to save lives go to waste because of asymmetrical information.

In our efforts to locate automated external defibrillators (AEDs) locations, we have collaborated with a volunteer organization The Extraordinaries ( to get iPhone users to locate AEDs worldwide. You can view some of the AEDs that were located by iPhone users at For the public to participate, they just need to follow our org "First Aid Corps" in that app to get access to our missions.

How the world society benefits is that we have an iPhone app to locate AED locations throughout the world. It is called AED Nearby. You can view the screenshots and a video on it at You can download it for free from the app store.