In addition to lives, checklists save money
Filed under: Health data, Health policy, Hot Health Headline, Studies
Last year, Atul Gawande and company made a splash by showing what a profound clinical impact checklists made on patient outcomes. Now they’re back, but this time the checklist evangelists are aiming for the pocket book. In the latest Health Affairs, Gawande and seven others contributed a paper with the descriptive title “Adopting A Surgical Safety Checklist Could Save Money And Improve The Quality Of Care In U.S. Hospitals.”
Photo by cybrjoe via FlickrHere’s their arithmetic, courtesy of The Boston Globe’s Elizabeth Cooney
Time was the biggest cost in setting up the checklist, Gawande and his co-authors write in the journal Health Affairs. They estimated that a hospital with at least a 3 percent rate of complications per year would begin to see savings after five major complications were prevented. That means a hospital where 4,000 noncardiac operations were done each year could save about $25 on each procedure, or about $100,000 annually, they concluded.
As always, free access to Health Affairs studies is one of many perks enjoyed by AHCJ members.
Are insurers to blame for rising costs?
The San Francisco Chronicle’s Carolyn Lochhead and Victoria Colliver use the recent furor over insurer Anthem’s rate hikes to explore just how much of the blame for rising health care costs should be shouldered by insurers. The reporters find that, in the end, insurers are just another one of the cartels (others include device makers and providers) and operate inside the opaque world of medical pricing and snag hefty cuts for themselves. Lochead and Colliver put it thus:
While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.
Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.
The reporters write that, despite their best efforts, they weren’t able to get many folks on the record. When they did find someone who was willing to talk, it was often a source we’ve seen before in other cost stories. It’s a tough theme to get quotes on, as nobody wants to burn bridges with their professional suppliers and everybody’s got some sort of skin in the game. They did, however, manage to find a local source who offered an original and illuminating anecdote:
Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.
“But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200,” Bernstein said. “It’s ridiculous. There’s no open competition.”
(Hat tip to AHCJ Immediate Past President Trudy Lieberman, who wrote a column on CJR.org praising the Chronicle’s story.)
Dental credit cards raise questions, debt
Capital Public Radio’s Kelley Weiss reports that more patients are using “Dental credit cards,” lines of credit that carry high interest rates but may enable some patients to afford costly dental procedures. Plastic surgeons and veterinarians also use the cards. Despite the endorsements of dental organizations and availability at about 100,000 providers nationwide, growing numbers of patients are complaining about the cards and their issuer, CareCredit.
“It’s a new trend that we’re seeing,” said Elizabeth Landsberg, an attorney with the Western Center on Law and Poverty. “We didn’t have any of these cases in 2006. We saw some in 2007, and we saw a lot more in 2008.”
Landsberg says states are just starting to pay attention to this problem, and California’s ahead of the curve. That state is now tracking complaints, and this year saw nearly three dozen, she says. Most of these were from the poor, the elderly and non-English speakers.
Landsberg accuses CareCredit of predatory lending practices. She says people can get broadsided by a retroactive interest rate of as much as 30 percent for a late payment.
A CareCredit spokeswoman said the company did not engage in predatory lending practices, and that the majority of the company’s customers are happy.
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