On Medicare Inefficiencies and Healthcare Waste

Last Updated: November 13, 2016

Medicare Doesn't Know How Old You Are … Even Though It Knows Your Birthday :-)

There has been a lot of talk in recent years about reducing waste and inefficiency in healthcare as a way of cutting costs. I think this is a goal worth some serious efforts, both on the part of patients, as well as from providers and insurance administrators.

I am more familiar with effors made by medical providers, and I can say most physicians I work with are cost-conscious and we do our best to keep costs down by avoiding duplicate or unnecessary tests and educating our patients on preventive measures and healthy lifestyle habits.


Medicare Doesn't Know How Old You Are

A detail from a Medicare prior authorization form listing patient's birthday and then asking the physician whether the patient was younger than age 2 or not. Click on the picture for a higher resolution image of the entire form.

No Progress Seen In Simplifying Administrative Inefficiencies

I am afraid I haven't seen any progress made when it comes to cumbersome, unnecessary, redundant paperwork that comes from insurance companies and piles up on my desk every day. Let me give you an example.

It is just a small example I came across a couple of days ago: Medicare sent me a prior authorization form for a prescription I wrote for a patient whose date of birth is 09/16/19-- (I blotted out the last two digits of the birth year as well as any other patient personal information for privacy reasons). I know Medicare knows this - in fact they list the date of birth on the form under Patient DOB. A few lines down, though, they are asking me to state whether the patient is 2 years or old or not.

In an era of electronic medical records, and at a time when Medicare and other insurance companies are making it practically mandatory for physicians and hospitals to switch to paperless records, it appears that Medicare doesn't have the ability to calculate its members age, even thought they know their birth dates. Instead, they rely on their physicians to provide this information.

Or could it be that whoever designed these forms never put an ounce of thought into simplifying them so they take the least amount of time possible to fill?

Final Thoughts

This is, admittedly, a small example of inefficiency in our healthcare system. But small things add up. And, while I don't intend or have time to list all variations on this theme I encounter almost daily, believe me, they are there. According to a position paper by the Medical Group Management Association,

Simplifying our healthcare system's administration could reduce annual healthcare costs by almost $300 billion.

I just hope all this talk about reducing inefficiencies will translate into something real, palpable for our patients. And, perhaps, the ability for Medicare and other insurers to do simple arithmetic so I don't have to answer stupid questions like the one above.

Just hoping…

Dr. Gily Ionescu MS, MD.

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