Mount Sinai Research: $6.7 Billion Spent on Unnecessary Treatment in One Year

Monday, October 10th, 2011
This post was written by Cheryl Miller

Are physicians prescribing unnecessary medications or performing unnecessary tests?

That is the $6.7 billion dollar question this week, given the results of a recent study from Mount Sinai Research. The answer? Well, according
to this data, 86 percent of the excess spending is attributed to the prescription of brand-name rather than generic statin medications for the treatment of high cholesterol. Other reported areas of excess spending included the over-prescription of antibiotics for sore throats in children ($116 million in costs) unnecessary bone density scans ordered for younger women ($527 million in costs) and needless CT scans, MRIs, and x-rays for people with back pain ($175 million) We list more details in this week’s issue of Healthcare Business Weekly Update.

Also contributing to excess healthcare costs — $17 billion annually — are hospital readmissions, which persist, especially among the elderly. According to a new Dartmouth Atlas Project Report, roughly one in six Medicare patients end up back in the hospital within 30 days of being discharged for a medical condition. Given the upcoming financial penalties from CMS for excessive readmissions, hospitals need to address this problem.

One place to start could be by maintaining contact with the patient upon discharge: the Dartmouth study also found that more than half of Medicare patients discharged home do not see their primary care physician within two weeks of leaving the hospital.

And here’s one possible solution: embedded case managers. They were crucial to CDPHP’s clinical transformation, helping chronically ill patients to better manage their diseases and helping to reduce
hospitalizations and costs and improve quality of life.

Another possible strategy? The new medication adherence tool being introduced by Merck. Targeting the high percentage of Americans that fail to take their medications as directed, Merck is hoping its online Web site will help consumers stay on course with treatment and have more informed discussions with their physicians about the medications they have been prescribed.

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