IHI: Berwick on ACOs, Congress, Fraud
But Congress is in another world, he said. "I think Congress has to catch up," he continued. "They're the ones who are behind. The nation is doing this and the Congress is missing the boat. And eventually, they'll be on the boat because eventually they will discover that after all, the change is here. I think I sense that. It won't go over (at the same pace) in every community. But there is not cause for despair here. There's cause for optimism. And Congress isn't connected."
Fraud and Other Cost Drivers
Berwick also said he was surprised that fraud, waste and abuse are a much more significant problem than he realized before joining the agency. He estimated the total at about $30 billion a year for the whole healthcare system and $8 billion to $10 billion a year just within CMS. "When I went there, I didn't know how big, but it is big...20% to 30% of the total bill."
He identified six major drivers of healthcare costs:
1. Failure of coordination: "When handoffs don't go well, costs go up and quality goes down," he said.
2. Process failures: When you're executing a process but don't do it correctly, scientifically or reliably. One big example, Berwick said, is hospital-acquired infections.
3. Overtreatment: "There's a lot done in healthcare that can not possibly help the patient and I'm not talking about end-of-life care. I'm talking about you and me when we go in when we have a viral cold and we get an antibiotic," he said.
4. CMS's own administrative burdens: Numerous record keeping and administrative requirements and forms. CMS has launched an effort to delete many of these mandates that don't add value or quality to care.
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