So, the records help a lot, but the HUGE dollars required to keep end of life patients alive represents a significant part of the Medicare dollar. Allan

But I’ve heard from other medical professions that one of the biggest areas of waste is the lack of computerization of patient records. I have an HMO myself and everytime I have to visit a new doctor it seems like I spend countless hours filling out forms. There are already gigantic databases that store all sorts of our info, why do I have spend an hour filling out forms everytime I go and visit a doctor?

This is certainly an uncomfortable subject for many to broach in the healthcare reform debate, but I think it is absolutely critical. Having been involved in Healthcare for the past decade I too have seen firsthand the waste and misallocation of resources. From purely an economics perspective, one must ask where the resources need to be directed. If you were investing in the infrastructure of your business you would no doubt invest in those areas that would yield the greatest return. Although it may sound or appear callous, we must address issues such as end-of-life treatment, with a similar ROI framework at hand. With universal coverage, at the expense of taxpayers, becoming more a probable reality, an examination of the maximum utilization of our healthcare dollars must be undertaken. Simply stated, although the preponderance of healthcare dollars are spent on the elderly, this is not necessarily the populace that will give society the greatest return for their dollars invested. I agree that astronomical amounts are currently being spent for “hopeless” cases where the statistical probability of cure or improvement in quality of life is extremely low. Many practitioner’s order needless tests, administer unnecessary drugs, and perform treatments just because there is a CPT or DRG that medicare or other commercial insurers will reimburse. I believe a good start to the conversation is to develop a model whereby practitioners have more skin in the game and can share in the economic losses that occur if substandard or unnecessary care is delivered. Conversely, higher quality levels of care delivered at profitable, and system sustaining levels, would be rewarded.