Clinically, Still Fat to Be Cut

Posted on March 26, 2013


The primary statistic on waste in the U.S. healthcare industry has been consistent over the past three or four years:  1/3 of healthcare spending is wasted.

In the U.S., the sources of unproductive healthcare spending are linked to, in ascending order:

  • Missed prevention
  • Fraud
  • Overcharging
  • Inefficient delivery of clinical care
  • Administrative inefficiencies
  • Unnecessary care

Unnecessary care, $210 billion worth according to The Advisory Board, was #1 in 2009. As an architect, there is not much I can do to reduce unnecessary care.  As a patient, I have been a witness to it twice in the past five months.

Case one:  Five months ago, I took my four-year-old to her first dentist appointment at a pediatric dentist. She loved it; it was an encouraging experience. After speaking with the hygienist, the dentist came in for a consultation. My daughter’s teeth were healthy and uncrowded, yet the dentist encouraged me to get a full set of dental x-rays done. Why, I asked?  She’s four. ‘Well, you can see how the permanent teeth are developing.’ I politely declined, and said I would consider it in the future. Unnecessary.

What exactly would I accomplish by seeing the partial development of my daughter’s future permanent teeth two-plus years before they descend? Sure, my insurance would pay for it, but so what? I later did an internet search on the American Dental Association’s guidelines for pediatric dental x-rays and found that they were discouraged unless medically necessary. I did not see the medical need.

Case two:  My big toe ached last week, a lot. After three days, I recognized it was infected, and on the fourth day of pain I called a podiatrist to set up an appointment.  The associate I spoke with said ‘we’ll have to take x-rays’.  I asked why. ‘The doctor will need to see if the infection is affecting the bone.’ I am a healthy 37-year old male with no chronic health conditions and good circulation.  An infection that sinks to bone in five days—is that possible?  Ok, maybe one foot. ‘The doctor will need to compare your good foot with the potentially infected foot.’ Smart answer, but I was not buying it. Unnecessary.

I was being told, sight unseen, that x-rays were necessary. My toe could have had a splinter in it and the tech was determined to schedule me for some x-rays. If I had insurance, they would be covered. Well, then that makes it ok, doesn’t it?  What I found more disturbing was both feet needed an x-ray. I think a board-certified podiatrist with 30+ years experience, which this one had, knows what a healthy x-ray looks like—and should not need to look an an unaffected foot, simply to get a comparison. He could also determine if the infection was likely to be at the bone. I asked that the x-ray decision be made at the time of my appointment after consulting with the doctor.

As an architect with an MBA, I help sniff out if a capital healthcare project is unnecessary. Just today, I had a good conversation with a Director of Strategic Planning who was questioning the viability of a project based on future reduced reimbursements. Good man. As an architect, it takes some courage to question, and not play along with a charade. If there is no business reason, why fake the need for a project?  Let’s kill it now (or at least postpone) before valuable resources are wasted. Cut the waste; cut the fat.

As a patient, all I have is my gut and knowledge of my own body to argue for, or against, proposed treatment. It takes some courage to ensure I am a part of the treatment decision, as opposed to something being done to me.  Insurance coverage or not, I want to approve only what is medically necessary for my well-being. If there is no medical need, why bluff—just to run up costs for my insurer?  Let’s kill the unnecessary care (or at least postpone it) before valuable resources are wasted—and my premium goes up.  Cut the waste; cut the fat.

Asking a lot of questions, in both cases, keeps people honest and costs down. From the facilities side, wasteful projects are definitely down. From the patient’s side, wasteful care is still out there.  Cut the waste; cut the fat.