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Waste in U.S. Health Care: Your First-Hand Accounts

According to the Institute of Medicine, about 30 percent of U.S. health care spending (about $750 billion) was wasted in 2009 on unnecessary services, excessive administrative costs, fraud and other problems.

It’s a problem that touches nearly every American in every state, each time they interact with the health care system. That’s why we wanted to hear from the experts: you. (More on that below). But first, a little background.

On air and online this week, the NewsHour has examined why health care in the U.S. costs 2.5 times more than most other developed countries, how hospitals and patients can make personal health care cheaper, and what the U.S. could buy with the money wasted in the health care system.

If you missed it, watch health correspondent Betty Ann Bowser’s report on how one medical center in Seattle has become “waste neutral,” eliminating everything from unnecessary procedures to waiting rooms:

Read the full transcript here.

Now, we’re turning it over to you to do a little reporting. With the help of the Public Insight Network, the NewsHour asked Americans to share their first-hand accounts of the waste they’ve seen in U.S. health care system and what they think could be done to fix it.

This is just a start. We want to hear from you, too. If you have a story to add, please share it in the comments section below.

Read some of their responses below. (Entries are first-person accounts. There claims were not verified by the PBS NewsHour. We also were not able to obtain explanations or statements from a doctor or hospital connected with any of these accounts.)

Tom, 71, Retired Electrical Engineer, Florida

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: Because I am a diabetic, I see two different doctors on a regular basis: a family practitioner and an endocrinologist. And one time, both doctors wanted blood work done.

So, I went to give blood and tried to coordinate there with the lab. I said, look, both doctors want blood for the same test, but the lab insisted we do two separate tests. So, duplicate blood was taken, and duplicate tests were performed, even though the two orders may have some of the same tests prescribed.

I’ve tried asking the lab to combine the tests but they won’t, nor will they allow me to add the other doctor’s name to the order so both doctors get the report. It’s crazy to pay for two different lab tests.

Q: How do you think such problems could be fixed?

A: If my medical records were contained in an online account, and I gave both doctors the approval to work together, they could see the open lab order, and add their tests and add their name to the list to see a report.

The online order would then be available to the lab when I arrived, so only one of each of the tests would be run. The reports (which are sent to the doctors by computer anyway) could be accessed by each doctor and only contain results of the tests they asked for.

Michael, 34, Author/Freelance Writer, Nebraska

Platte River, Neb., about 20 miles from Michael’s parents’ home.

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: Just over one year ago, my father was diagnosed with esophageal cancer. The first procedure necessary was the insertion of a feeding tube, since he would not be able to swallow. The surgeon who was assigned this relatively simple surgery assured us it would be a simple, outpatient procedure. But, he was supposed to have a radiologist with him for the surgery. The radiologist was not available, so, instead, the surgeon decided to go ahead. Not only was he unable to successfully insert the feeding tube, he pumped a large amount of gas into my father’s abdomen, which resulted in a week-long stay in the hospital from the pain. This was before he even started chemo and radiation.

Later, when each time Dad was supposed to check out of the hospital (he went in several times, mostly to keep him on IV food and fluids), it seemed every doctor who ever stopped in his room to say “hi” needed to OK his departure, but none of them wanted to be the one to sign his name on the discharge papers.

They would tell Dad in the morning that he was going home, which would brighten his day. But it would be 7 p.m. before they would finally stop messing around and take the five minutes needed to sign him out. He would be completely exhausted, both physically and mentally, which is not how you want to be when recovering from cancer treatments.

Q: How do you think such problems could be fixed?

A: In the first case, the doctor should have postponed the surgery until all the necessary people could be there. His actions were wrong.

In the second, there needs to be clear, and unquestionable rules on check-in/discharge of a patient. There needs to be better coordination between doctors. Nobody wanted to take the responsibility because if something happened to Dad, it would be their name on the discharge papers, and, thus, their name on the malpractice suit. They were too scared to do their jobs. It was simply pathetic.

Jonah, 31, Emergency Room Travel Nurse

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: A patient was seen 62 times for “sickle cell crisis” and it was only June; sometimes he would come three times in one day. Each time, he was administered a narcotic (Dilaudid; five to eight times more powerful than morphine) and most times an injection of Benadryl, which not only prevents reactions but also potentiates narcotics or makes the high greater.

The patient was self-pay and although he may have had an outstanding balance, the Emergency Medical Treatment and Active Labor Act (EMTALA) forces an ER to see him. Anyone who doesn’t have a primary doctor is automatically referred to follow-up. Referral must always be given (hence why same patient comes back to the ER). How reasonable the referral is questionable.

Q: How do you think such problems could be fixed?

A: Two things:

  • Revisions to EMTALA, Centers for Medicare and Medicaid Services, etc., in order to prevent patient-satisfaction-driven care solely.

  • Public education on appropriate reasons to call an ambulance would also help bring down costs, as well as education on when to visit ERs ($$$) vs. urgent care ($$) vs. doctors offices ($). Simple commercials would even help. If people are using the ER as a place to get primary care, it’s so ineffective.

Martin, 59, Scientific Programmer, Sandia Park, N.M.

Martin and his wife Julia on vacation near Mt. Rainier.

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: I realized my memory wasn’t working as well as it used to, and following the literature, decided that I wanted Azilect (rasagiline) for its neuroprotective effects to hold off further decline. I asked for it from my general practitioner but she did not feel comfortable prescribing it, so she referred me to a neurologist. He gave me an MRI and an EEG, but after two visits said he didn’t feel comfortable prescribing it either. But I insisted I liked its side effect profile better than what he was recommending, so he referred me to [another] neurologist. That neurologist finally prescribed it for me.

Once I’d been through all those tests, my local general practitioner was willing to prescribe [rasagiline].I haven’t noticed any side effects and I feel a little sharper. The biggest difference I’ve noticed was that I started having more intense dreams like when I was younger.

Q: How do you think such problems could be fixed?

A: If the Food and Drug Administration informed instead of regulated… people could opt to choose only FDA drugs if they wanted to and they could opt to speak with a physician.

Nurses could start prescribing for chronic conditions like high blood pressure, diabetes, arthritis and cholesterol.

Ellen, 47, Mental Health Worker, Ashburn, Va.

Courtesy of New Valley Free Clinic.

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: Working with low SES(socioeconomic status) clients for over three years at a free clinic allowed me to experience the great need for more medical/mental health clinics in rural areas to help low-income populations.

Q: How do you think such problems could be fixed?

A: The New River Valley Free Clinic up in Blue Ridge Mountains is a free clinic that offers a pro-bono program. Since mental health is all under one umbrella, it makes for a more holistic approach. It’s a huge need in these areas where people don’t have health care unless it’s there.

We need more clinics and practitioners.

Ellen, 47, Market Research Consultant, Johns Creek, Ga.

Ellen researches her health concern.

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: My annual mammography screening was a few weeks ago. The technician was concerned about an area and recommended a second diagnostic mammogram. This second diagnostic was inconclusive apparently, so they ordered an ultrasound. The ultrasound was, at first, said to be clear. But then a secondary technician went looking around and other areas without reason and found “something.”

The doctor was at first not concerned, but then on second thought ordered an ultrasound guided biopsy. In the meantime, I did some research and was 99 percent certain the area they saw was simply a benign cyst.

After three weeks of back and forth, I went in. Hundreds of dollars and two hours later, I learned it was a tiny cyst that disappeared upon needle impact.

I am extremely fortunate to be healthy, but the screenings and scare tactics eating up the system and our money seems borderline unethical.

Q: How do you think such problems could be fixed?

A: Improving communication so that the patient doesn’t seem so at the mercy at the system. Perhaps we need to get more individualized consideration versus general statistics. We should not rush into invasive testing but give things a little more time and re-screen. I think of what I did and I imagine that if this same thing is happening all over, then there are millions being made and lost.

People like myself get scared at the “but what if” scenarios and think they do not have a choice. We need more flexibility based on our individual situations.

If the same thing happened again, I’ll likely do the same exact thing — so I feel like I am going along with the broken system — but with a family and hopefully many healthy years ahead, how am I to say “no”?

Stacey, 47, Self-Employed, Downingtown, Pa.

Stacey with her husband.

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: My husband works for UPS and during the hot months of last summer, he experienced two bouts of dehydration. At the time he was having symptoms, we did not know it was dehydration, so we went to the emergency room because he had heart palpitations and dizziness, etc.

During the first trip to the ER, they immediately did the cardiac workup and gave him Ativan to calm him down (my husband is a recovering alcoholic with 15 years sobriety). He needed fluids so they gave him an IV and after about four hours he felt better. They suspected dehydration, but did not clearly give instructions on any type of follow-up.

The next weekend, after working in extreme heat, my husband experienced symptoms that were more intense. Off to the ER again for another cardiac workup. This time they kept him in the hospital for three nights (all the while giving him Ativan for panic attacks). A cardiologist told my husband that he had right heart enlargement and “pulmonary hypertension” and upon release from the hospital he should follow up with a pulmonary doctor. My husband is 47 and is in great shape and has worked out his entire life. They did not even seem the least bit interested in knowing these facts, or the fact that he has alcohol intolerance.

Long story short, my husband really thought he was going to die. He went through three months of pulmonary and invasive cardiac testing. The Ativan was producing the most intense side effects on him; he was having more panic attacks, sleepless nights (never before), heart palpitations and paranoia. He was a walking time-bomb! A cardiologist at University of Pennsylvania in Philadelphia finally put to rest this false diagnosis of “pulmonary hypertension” and deemed my husband extremely fit and full of life (the mild right heart enlargement he has is due to being very fit!). I’m not sure of the total monetary expenses that our insurance company paid out, but I’m sure it was probably close to $100,000 easy, but the emotional expense is something that we can’t put a price on. It took months for my husband to wean off of the Ativan and actually start to feel somewhat normal. And it took another nine months for him to trust that he isn’t going to die from pulmonary hypertension. If the first cardiologist would have had more insight and spent more time learning about my husband and his health history, my husband would never have had to got through those months of invasive, stressful testing.

Q: How do you think such problems could be fixed?

A: Doctors have to be more aggressive in gathering pertinent background information from their patients.

Cade, 52, Retired, Dominican Republic

Cade Johnson

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: I was doing a lot of work on my boat, getting ready to sail off to the Caribbean as part of my plan to retire. During that time, I strained a muscle and had some abdominal pains. I went to my primary care doctor for this pain and the doctor recommended that I go to an internal specialist because sometimes serious issues in the abdominal region of the body are very difficult to diagnose.

For the specialist, I went to a hospital facility in Tampa, that was in-network for my insurance plan. There, I saw an internist, had a CT scan and then had a follow-up visit with the internist. The specialist and his facility were “in-plan” and I had a 10 percent co-pay. I received some bills which I paid at the time of the procedure, or within two months thereafter.

In March 2001, I retired, left the company and ended my employer-provided insurance plan. Almost simultaneously, I received a batch of new bills from the specialist’s facility that were described as “not covered expenses.”

I wrote to the facility, explaining that these new bills were not timely — almost six months late, and that they would have to resolve their accounts with the insurer or not at all. I wrote the hospital back to tell them I had already made his co-payments.

Q: How do you think such problems could be fixed?

A: I think the insurance industry processing system is very complex. Of course it is devised to be as efficient as possible, but apparently this sometimes means leaving out the patient in the paperwork path.

The rate at which that stuff gets billed is what needs to be fixed. The hospital did not bill me in a timely manner. The specialist could have (and maybe should be required to) give me a list of bills to expect from the procedure. It would even have been nice to have that list in advance.

Joe, 56, Retired Physician, Charlotte, N.C.

Joe with his wife and two daughters.

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: My two daughters got burned by a new billing practice that is unique to doctors’ offices that have been bought out by hospitals.

When a healthy person goes in for preventive care, they charge a preventive care visit, which is paid for by insurance. However, if the patient has any minor symptoms, they generate a second code for a problem visit with a resulting $200 to $300 charge which adversely affects people with high deductibles such as an HSA.

Since a large ratio of people who do not qualify for Medicaid will be mandated to buy health care as employers reduce their contribution to premiums, many millions of people will have this bogus charge added to their bills. BCBS is not interested in this issue. It will cause people to not get preventative care. It will effectively gut the so-called Obamacare making preventative care unreachable.

Q: How do you think such problems could be fixed?

A:This practice of adding this extra charge which used to be called un-bundling has to be stopped.

Elizabeth, 66, Retired Licensed Nurse, Chicago, Ill.

Q: Give an example of inefficient or wasteful practices you’ve personally experienced, or witnessed, within the U.S. health care system.

A: Before I retired, I worked for home health care agencies in Wisconsin and in Arizona. Through these agencies, I would be sent to different nursing homes and occasionally, I would get assigned to private duty in a home or a hospital room.

From 1993 to 1995, I took care of a boy in Arizona, who suffered from a diabetic coma. Though I was originally hired through a home health care agency, it became too expensive for the family, so the family then hired me privately and independently of the health care agency.

Home health care agencies have certain rules or regulations set up so that they feel that they are educating their personnel. But see, the state has me licensed already. When I would go to a meetings required by the agency, I would have to learn ridiculous ‘in-services’ that seemed like a waste of money and a waste of time. One sponsored by a company taught nurses how to use fit face guards that we never used. It was bogus. I was trained for treatments and services I never used with my patients.

Q: How do you think such problems could be fixed?

A: You could save Medicare and the nursing homes 50 percent by cutting out the middle men of home health agencies. It’s a false good to believe that these agencies are able to check up on the registered nurses.

Each state has a list of every person who is a licensed nursed. If there was a database system, that when a doctor felt a private duty care nurse was needed, he could list with all the active and available private duty care nurses, the doctor could simply link the patient with the nurse, as well as inform the nurse of the patient’s needs.

Workers should be recruited through state registrars and any complaints of their work could be made to states, which carry out disciplinary action already. As long as health care workers are licensed by states, workers don’t need to be hired and monitored by agencies. These health agencies are middle men we do not need.

Related Content

We continue our health cost coverage with a week-long exploration of why the U.S. system is so expensive and some possible solutions to fixing it.

Full lineup:

Monday: Why are U.S. health care costs more than two-and-a-half times more than most other developed countries? We talk with Mark Pearson, head of Division on Health Policy at the Organization for Economic Co-operation and Development, about some of the cost-containment strategies that have worked elsewhere in the world.

Tuesday: What steps can you take to make your next hospital stay safer and cheaper? Hari Sreenivasan talks with Elizabeth Bailey, author of “The Patient’s Checklist: 10 Simple Hospital Checklists to Keep You Safe, Sane and Organized.”

Wednesday: We illustrate what the U.S. could buy with the $750 billion wasted in American health care each year, and, in a separate post, our partners at Kaiser Health News examine the “Top 7 Drivers of U.S. Health Care Costs.”

Thursday: In a “Reporter’s Notebook,” Betty Ann Bowser examines Virginia Mason Medical Center’s decision to eliminate a staple of the American hospital: the waiting room.

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