“A billion here, a billion there …”
“… and pretty soon you’re talking real money.” The late Senator Everett Dirksen (R-IL), a politician who often spoke passionately about the debt ceiling, federal spending and the growth of government, is rumored to have made this statement to reporters about the way Congress thinks about the federal budget. Well, the Rand Corporation may have found a billion dollars that can be taken off our nation’s yearly health care tab.
In a study published by the Journal of the American Medical Association a year ago, researchers at Rand concluded that $1.1 billion in savings per year could be generated by eliminating the discretionary use of anesthesia providers during gastroenterology procedures. The key findings of their study included the following:
- The use of anesthesia providers to deliver sedation during routine gastroenterology (GI) procedures is seen as medically justifiable only for high-risk patients who require intensive monitoring.
- But between 2003 and 2009, the proportion of GI procedures involving anesthesia providers doubled, and overall payments for GI anesthesia tripled.
- The use of anesthesia providers varied by almost a factor of four across U.S. regions.
- The majority of patients who received sedation from an anesthesia provider rather than the endoscopy team were not high-risk patients.
- Eliminating potentially discretionary use of anesthesia providers for low-risk patients could generate $1.1 billion in savings per year.
Hardly seems worth talking about, given the reality that we will spend more than $2.4 trillion dollars on health care in the U.S. this year, right? Nay, I think it should be talked about because this practice speaks to a kind of wasteful thinking in the delivery of medical care that needs to change, and because I also agree with Benjamin Franklin, who said, “Watch the pennies and the dollars will take care of themselves.”
More importantly, this study serves as an example of the comparative effectiveness goals embodied in health care reform that I wrote about in a previous blog. This federal cost-cutting initiative calls for the government to study hard data associated with health care delivery to determine where the greatest savings can be made that will improve overall quality and outcomes. In that regard, I hope the Patient Centered Outcomes Research Institute set up to oversee this initiative will not shelve the benefits to be derived from research like the Rand study on routine GI procedures in its quest to save big bucks.