The Impact Of Reducing The Cost Of Healthcare

Submitted By ericalamy
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I do not feel that decreasing the cost of healthcare will directly decrease its quality. There are many inefficiencies within our current system that need to be addressed. If these inefficiencies were eliminated we would be able to decrease cost and it would have no effect on the quality of care. The Institute of Medicine (IOM) has created a Committee on the Learning Health Care System in America. This committee is working to develop methods of "Better Care at Lower Costs" and has discovered three major areas that require focus in decreasing unnecessary spending. These three areas are; "the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential" (Smith, 2012). Healthcare informatics is assisting to bridge the gap between these problem areas and creating greater efficiency within our current healthcare system in creating an updated system "that aligns science and informatics, patient-clinician partnerships, incentives, and a culture of continuous improvement to produce the best care at lower cost" (Smith, 2012).

Opportunities to create greater efficiency can also be found in; "improving the Medicare coverage process; reducing unnecessary and harmful care; and empowering patients to participate in directing their own care through shared decision making and the use of patient decision aids, particularly in the area of end-of-life treatment" (Flemming, 2011). These opportunities have been endorsed by physicians who agree that there are many patients that patients are not being provided a beneficial service if it is "unnecessary, wasteful or harmful" (Flemming, 2011).

Improving Medicare coverage "Centers for Medicare and Medicaid Services to be more vigorous in ensuring compliance with its coverage decisions by providers" (Felmming, 2011). They are able to do this by increasing their budget for anti-fraud. It may sound like throwing money at a problem to find a better solution, however, "researchers have found that CMS anti-fraud expenditures produce returns in the neighborhood of six or seven to one" (Flemming, 2011). By increasing anti-fraud CMS would be able to reduce their cost and in turn offer improved coverage for the patients that they cover. I researched how much money is lost yearly in Medicare fraud to find out what type of an impact this could potentially have to the bottom line of cost in healthcare and fraud; "Federal Bureau of Investigation refers to estimates of 3-10 percent of all health care billings. In 2011, Medicare expenditures totaled approximately $565 billion. If the FBI percentages are applied to this amount, the cost of Medicare fraud for the 2011 fiscal year was anywhere from $17-57 billion. CMS also estimates that the federal government distributed about $65 billion in improper payments (payments that shouldn't have been made or were for an incorrect amount) through Medicare and Medicaid combined in fiscal year 2011" (How much money, 2011).

There are also a number of parameters that have been set in order to eliminate harmful or unnecessary treatment that has also resulted in additional spending. An example of a few of these parameters is as follows (Flemming, 2011): * Physicians should not image the lumbar spine region of patients with lower back pain in the first six weeks unless certain red flags are present; * antibiotics should not be prescribed for mild to moderate sinusitis unless symptoms persist more than seven days or worsen after initial improvement; * and generic
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