US Pharm. 2013;38(4):1.
In the years following “the Great Recession,” which nearly bankrupted this country, most of the financial news was rightfully centered on the greed of the banking industry and other financial institutions. Federal prosecutors and economists were so busy trying to sort out the reasons why the United States nearly sank into a second depression that little notice was given to other areas of financial concern, especially health care. Now that the scrutiny of financial institutions’ shady practices is not grabbing headlines as it once did, attention is being turned to dissecting the Affordable Care Act, which is about ready to unleash its full effects on health care in this country. This attention, to no one’s surprise, has generated some interesting facts about our existing health care system, particularly when it comes to fraud, waste, and abuse.
While fraud, waste, and abuse have been uncovered in virtually every facet of health care from prescription drugs to nonprofit hospitals, one might rationalize that given the excellent health care available to Americans, maybe a little waste is not such a bad thing. But when you pull back the layers of health care and expose its underbelly, you get an ugly and rotting perspective. In an eye-opening, well-researched report published by Time magazine titled “Bitter Pill” (March 4, 2013), author Steven Brill presents U.S. health care as a diseased organ. The report is much too dense to describe in detail here, but what it basically reveals is that health care outcomes do not justify the approximately $2.8 trillion likely to be spent this year by patients and government programs. For example, last year U.S. infant mortality ranked 50th in the world, nine slots below Cuba. The article is peppered with outrageous examples of overcharging in hospitals that were taken from real patients’ hospital bills—charges like $18 for a single diabetes test strip; $108 for a tube of bacitracin; $24 for a 500-mg niacin tablet; and $1.50 for one 325-mg acetaminophen tablet. Brill reports that “the U.S. has the highest annual per capita spending on hospitalization among developed countries; $2,300 per bed day on average.”
According to Jesse C. Vivian, RPh, JD, author of the U.S. Pharmacist monthly law column, pharmacy is not immune to its own brand of fraud, waste, and abuse. In a report released by Health and Human Services’ Office of Inspector General, approximately 2,600 retail pharmacies, or 4% of all U.S. pharmacies participating in Medicare, submitted suspicious or excessive billings to the federal government from 2009 to 2011. Organizations like the National Community Pharmacists Association (NCPA) say that many of the alleged fraudulent billings were actually clerical errors. As NCPA CEO Douglas Hoey, RPh, MBA, stated recently, “The fiscal integrity of government programs requires finding effective and efficient ways of rooting out fraud, waste and abuse.” Though retail pharmacy surely has its fair share of these, their extent pales in comparison to that of some other sectors of health care.
While I could write tomes about the negative side of our current health care system, I prefer to focus my attention on how to save American taxpayers the burden of paying for such excessive fraud, waste, and abuse. This would involve utilizing pharmacists in a more serious consultative role to make sure patients are taking their medications properly and on schedule, thus saving the health care system millions of dollars in unnecessary doctor and ER visits and hospital stays. Pharmacists are ready and willing to take on this new role. It probably won’t eliminate fraud, waste, and abuse, but it will go a long way toward fixing what is wrong with health care in America today.
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