The New York Times has an interview with former CMS administrator Donald Berwick. Berwick says that 20 percent to 30 percent of health spending is “waste” that yields no benefit to patients. He offered five reasons for this waste:- Over-treatment of patients – much of this is end-of-life medicine
- Failure to coordinate care
- Administrative complexity
- Burdensome rules
- Fraud
Much is done that does not help patients at all,” Dr. Berwick said, “and many physicians know it.”
5 comments:
I imagine the Doctor is happy to leave this job. It can't be fun to be a target of the Republicans who want to dismantle the Obama Health Care plan --which has already been terribly compromised because of their resistance to any change that would negatively affect the profits of the health care industry.
Have to agree with the Doctor that "at least" 30% (probably even more) of spending on Healthcare is waste of the government's money and for the reasons he mentions. Everybody steals from the government "legally" whenever possible.
The AMA and the Republicans don't want any rationing of outpatient care because this would ration PROFITS for the physicians, clinics, hospitals, drug companies, health services and medical equipment suppliers, etc.. Can't ration profits!
Obviously, this is why physicians weren't put under the 1991 Patient Self Determination Act ---because if they had to seek "informed consent" for end of life care, they would have to disclose the risks and the known odds of success of treatment etc., and this would have worked to "ration" outpatient care and thus, profits!
Hospice and Palliative Care, a lower and cheaper standard of care, (also delivered for profit over 50% of the time) is already a type of rationing of "end of life" treatment for the elderly on Medicare-TricareforLife/Medicade and the policies of PRIVATE Insurers who supplement or replace original Medicare -- for profit, of course.
I think Dr. Donald Berwick is a good man. I wonder if he knows that Administrative Rules concerning reimbursement are incentivizing the hospitals to put illegal DNR/DNIs into elderly patients' hospital charts because so often the hospitals aren't reimbursed for the care of these elderly Medicare-TricareforLife and Medicade patients under the Administrative Rules in place.
It does then save the hospitals money if the elderly dying patient dies sooner rather than later, and why shouldn't they have the right to determine that the patient is "better off dead."
Nothing personal, of course, and the AMA and the Bioethicists appear to be working together to legalize unilateral DNR/DNIs of the elderly and the younger throw-aways as a means of curbing the high costs to the insurance companies and government of old peopple dying in the hospitals.
Sing it, Doctor!
Anonymous, I need some sort of source to believe your assertion that physicians are implementing illegal de facto DNRs. I have never seen this. Ever. And the entire population which which I now and always have worked is either end-of-life or very close.
SuesquatchRN:
My personal painful experiences in two instances --and my personal research --have led me to the conclusions voiced in this Blog.
We did file a Civil Rights Complaint with the Office of Civil Rights of the Health and Human Services several months ago and they have accepted the complaint.
Under law, they are investigating the complaint under the provisions of the Age Discrimination Statute of 1975.
Hopefully, our case was an "exception" as I, like you, believe that most physicians wouldn't engage in activity that is against the law or that would mar their integrity.
But, when push comes to shove and money is involved, it is easy to rationalize that the "old" patient who has already enjoyed a long run is better off dead. But, of course, the law says the patient has to agree!
Because it is so easy to put "oral" DNR/DNIcode into hospital and nursing home charts, the unilateral decision is usually not even discovered. The law is not enforced and earlier exit and departure of the elderly becomes a solution to the fiscal pain.
What will our government do with my complaint? This is now my worry.
An RN, who followed the Doctor's orders, was involved in our situation. She is an excellent nurse and I liked her very much. I know this has been painful for her.
Hopefully, because patient unauthorized DNRs (no CPR) are against the law, it isn't happening all of the time. It depends on the hospital policy.
But, of course, when physicians can put oral and unwitnessed statements into hospital charts that aren't witnessed or confirmed with the patient (or the surrogate)by a neutral hospital source, most often the unauthorized DNR/DNIs are not discovered.
The patient is dead ---the matter is moot. What survivor would even think to ask for permission to look at the hospital chart and discover the unauthorized DNR? And how could they prove it was unauthorized if the DNR was based on an oral unwitnessed statement that the physician placed in the chart?
I know that an unauthorized DNR was put in my husband's hospital chart to DENY him the choice of having a tracheotomy or of dying --sooner rather than later. I believe this was done because the Hospital knew they wouldn't be reimbursed for the costs of the tracheotomy, if his choice was to die later rather than sooner.
For source: read the NYTimes Health Article "Passive Euthanasia the Norm in US Hospitals" and also read ISTOR: Medical Care, Vol 37, No. 8 (Aug.,1999), pp. 727-737 "Increased Risk of Death in Patients With Do-Not-Resuscitate Orders."
The DNR Code is a direct result of the request for "No CPR" and results in a premeditated lower and cheaper standard of care in the hospital setting.
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