While the U.S. Spends Heavily on Health Care, a Study Faults the Quality

Usually paying a premium for services and goods means you’re getting a product of higher quality in return. For example, organic produce costs more than conventionally-grown produce and octane 92 gas costs more than octane 89 but you get what you pay for: better fruits and cleaner gasoline.

According to a study conducted by Commonwealth Fund, a nonprofit research group in New York, this get-what-you-pay-for formula is not the case for the American healthcare system. The report shows that the United States spends more than twice as much on each person for health care as most other industrialized countries but has fallen to last place among those countries in preventing deaths through use of timely and effective medical care.

In summary: Americans are paying way too much for very little. The study also examines costs and inefficiencies within the American healthcare system. The administrative costs of the medical insurance systems consume much more of the current healthcare dollar, about 7.5 percent, than in other countries.

One avenue that healthcare payors can take to reduce costs is to outsource review cases to independent review organizations (IRO). IROs are efficient, cost-effective and knowledgeable, providing peer specialists who are actively practicing and up-to-date with today’s medical standards. By ensuring that reviews are done according to current medical standards, IROs reduce extraneous administrative costs of rework and re-reviewing.

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Aggressive New Recommendation for Warding Off Heart Disease in Some Children

By now, most people in the medical profession are aware of the American Academy of Pediatric’s recommendation for wider cholesterol screening for children and more aggressive use of cholesterol-lowering drugs for kids, starting as early as age eight. The controversy of the recommendation stems from the fact that the AAP’s statement comes from mere speculation of how statins work in adults. According to an article in The New York Times, AAP’s doctors believe that statins will function the same in children as they do in adults, a speculation that is absent of any evidence-based medicine and clear data.

The importance of evidence-based medicine is clear in this controversial mishap. Just two days after issuing the recommendation, AAP retracted the statement, offering apologies for unclear thinking and lack of evidence-based medicine. Relying on evidence-based medicine is a sure-fire way to make the best decisions for a treatment. An independent review organization bases its decisions and recommendations on evidence-based medicine in order to determine medical necessity and increase patient safety.
Read the initial article about the American Academy of Pediatric’s recommendation

The Evidence Gap: Weight the Costs of a CT Scan's Looks Inside the Heart

The latest feature of The New York Times series, The Evidence Gap, delves into controversial issue of emerging and cutting edge technologies in healthcare. The article, “Weighing the Costs of a CT Scan’s Look Inside the heart,” offers the pros and cons of a new cardiology medical device. The CT Scan can provide cardiologists with a new way of looking into patients’ arteries, a boasting reputation of offering cutting edge technology as well as extra revenue. On the other hand, the new CT Scan exposes patients to large doses of radiation. It is costly machine—$1 million—and an expensive procedure that has yet to yield better results.

According to The New York Times, this new CT Scan controversy showcases the American healthcare system as: “faith in innovation, often driven by financial incentives [which] encourages American doctors and hospitals to adopt new technologies even without proof that they work better than older techniques.” The CT Scan is just one of many costly procedures that leads to hundreds of billions of superfluously spent dollars, with no justification.

An independent review organization (IRO) is helpful in a situation like this because they back their decisions with evidence-based medicine. Furthermore, they weigh the benefits of a procedure—detecting heart disease—against its risks—high radiation exposure levels. All in all, an IRO can decide whether its medically necessary for a patient to receive a particular treatment, elimating unnecessary procedures, reducing the nation’s superfluous spending on healthcare, while making sure patient safety is the top priority.

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