Sparing Medicare: Savings to patients and providers

By Keith Dayton

Every four years, America gets embroiled in divisive political debate.  One presidential candidate claims the other wants to raise taxes.  The other retaliates by saying the first doesn’t care about the middle class.  Somewhere in all this, nuggets of truth are spoken.  One instance this election: both candidates are proposing large changes and cuts to Medicare—an unpopular idea regardless of your politics.

But what if other places in healthcare were cut instead?  A recent report by the Institution of Medicine said that the U.S. healthcare system wastes $750 billion every year on unnecessary care, a glut of paperwork, and other items.  Consider that it would take ten years of the Medicare cuts outlined in the Patient Protection and Affordable Care Act (a.k.a. “Obamacare”) to save this same amount.

So how can hospitals and healthcare providers effectively execute cuts?  New technologies are enabling healthcare organizations to revolutionize operations, respond to regulations, enhance the customer experience and manage change.  Healthcare organizations can easily work within their existing architectures to deliver seamless interactions across all channels.  Using business software that automates processes in a way that makes them easy to understand—cutting redundancies and improving efficiency for doctors, agents, patient advocates, billing departments, and hospital IT professionals—ensures more time and effort is spent caring for patients.

Cutting Down on Unnecessary Care

Several factors determine whether patients require tests, treatments, or procedures. While we can’t be too careful with health, redundant practices cost time and money.

In many cases, a simple sweep of medical records—for known allergies, family histories, recent doctors’ appointments—is sufficient.  A pre-existing condition should instantly show care information tailored so that options and treatments may be determined quickly.  If a blood test was administered one week before, why tie up the lab when it’s highly unlikely any changes would be evident?  Most patients see several doctors and it’s incumbent on them to remember their medications, why another doctor ordered tests, and which ones.  If patients forget or confuse something, the new doctor could prescribe medications unnecessarily.  But if electronic medical records (EMRs) can be adopted, processes like these will become more efficient, and ultimately safer.  Blood work doesn’t need to be drawn again, perhaps.

Removing redundancies doesn’t just make patient care more efficient; it makes it better.  Flexible software makes it easier to monitor in-patients and out-patients, by cutting back on unnecessary and sometimes traumatic re-hospitalizations, for example.  A rash that alarms a doctor without a complete patient history may not concern another doctor who accesses records and sees that grass allergies are to blame.  Doctors with full medical records can spend more time listening to patients, versus sorting through paperwork.  They’ll get to know patients better, and care can improve.

Shortening the Paper Trail

It’s not just redundant and unnecessary procedures that can be eliminated.  Extraneous paperwork and administration shrinks, too.  The IOM report states $190 billion of the $750 billion overspend can be attributed to excess administration costs—managing the paper trail of intake forms, insurance information, bills, etc.  There’s no reason for patients to complete the same forms every time they visit the doctor.  The information that’s different is what matters.  A change of address can be noted in one place, not three.  If a patient is taking a new medication, the system should automatically flag any other medications that could counteract it.  Advanced technology empowers practitioners to become more agile, so they can focus on quality of care, and administrators can better target customer satisfaction. 

Implementing Changes to Implement Savings

The idea of completely revamping legacy technology will always be a tough sell.  It’s too expensive to roll out a new system, some may say.  The 2014 EMR mandate deadline is a strong push in the right direction—but depending on how EMRs are employed, they may prove to be an added layer of cost and inefficiency instead of a solution to the overage problem.  Will the new system make it easier to send/receive records from other doctors?  Or will you still have to print-fax-scan?  Do you have the flexibility to make database changes, or do you have to put in change orders with your IT team?

Healthcare, much as many practitioners hate to admit, has to be run like any other successful business.  Deploying technology that helps them run smoothly drives more efficiency.  An investment in new software will pay for itself very quickly.

If this can cut costs, and help to stave off some potential Medicare cuts, it’s a no-brainer.

Keith Dayton is Senior Director, Healthcare Solutions, for Pegasystems in Cambridge, Mass.

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