ROBERT KELLEYVICE PRESIDENTHEALTHCARE ANALYTICSTHOMSON REUTERSOCTOBER 2009Where can 700 billion in waste be cut annually 3TUJNBUFTTVHHFTUUIBUBTNVDIBTCJMMJPOBZFBSJOIFBMUIDBSFDPTUTEPOPUJNQSPWFIFBMUIPV ID: 897596
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1 WHITE PAPERWHERE CAN $700 BILLION IN WAS
WHITE PAPERWHERE CAN $700 BILLION IN WASTE BE CUT ANNUALLY FROM THE U.S. HEALTHCARE SYSTEM? ROBERT KELLEYVICE PRESIDENT,HEALTHCARE ANALYTICSTHOMSON REUTERSOCTOBER 2009 Where can $700 billion in waste be cut annually? 3 ² & T U J N B U F T T V H H F T U U I B U B T N V D I B T C J M M J P O B Z F B S J O I F B M U I D B S F D P T U T E P O P U J N Q S P W F I F B M U I P V U D P N F T 5 I F Z P D D V S C F D B V T F X F Q B Z G P S N P S F D B S F S B U I F S U I B O C F U U F S D B S F 8 F O F F E U P C F N P W J O H U P X B S E T B T Z T U F N J O X I J D I E P D U P S T B O E I P T Q J U B M T I B W F J O D F O U J W F T U P Q S P W J E F U I F D B S F U I B U N B L F T Z P V C F U U F S \r S B U I F S U I B O U I F D B S F U I B U K V T U S F T V M U T J O N P S F U F T U T B O E N P S F E B Z T J O&#x U I;&#x F 0; I P T Q J U B M ³ ± 1 F U F S 0 S T [ B H \r E J S F D U P S P G U I F 8 I J U F ) P V T F 0 G ¾ D F P G . B O B H F N F O U B O E # V E H F U \r . B Z J O U F S W J F X X J U I / 1 3 + B D L 8 F O O C F S H P G % B S U N P V U I µ T $ F O U F S G P S U I F & W B M V B U J W F $ M J O J D B M 4 D J F O D F T J T P G U F O R V P U F E B T I B W J O H T B J E ² © V Q U P P O F U I J S E P G U I F P W F S U S J M M J P O U I B U X F O P X T Q F O E B O O V B M M Z P O I F B M U I D B S F J T T R V B O E F S F E P O V O O F D F T T B S Z I P T Q J U B M J [ B U J P O T V O O F F E F E B O E P G U F O S F E V O E B O U U F T U T V O Q S P W F O U S F B U N F O U T P W F S Q S J D F E \r D V U U J O H F E H F E S V H T E F W J D F T O P C F U U F S U I B O U I F M F T T F Y Q F O T J W F Q S P E V D U T U I F Z S F Q M B D F E B O E F O E P G M J G F D B S F U I B U C S J O H T O F J U I F S D P N G P S U D B S F O P S D V S F ³ 5 I F . D , J O T F Z ( M P C B M * O T U J U V U F \r J O B T U V E Z \r D P N Q B S F E 6 O J U F E 4 U B U F T 6 4 \n I F B M U I D B S F D P T U T U P U I P T F P G P U I F S Q F F S 0 S H B O J [ B U J P O G P S & D P O P N J D $ P P Q F S B U J P O B O E % F W F M P Q N F O U 0 & $ % \n D P V O U S J F T B O E G P V O E U I B U U I F 6 4 T Q F O U O F B S M Z C J M M J P O N P S F P O I F B M U I D B S F 11 INTRODUCTION How America will pay for healthcare is a subject on the mind of virtually every American today. As Congress determines who will pick up the tab for this important and growing expense, it is worthwhile to take a close look at the cost of healthcare itself. Are there areas where expenses can be cut without undermining the quality of care provided? How prevalent are misuse, overuse, and fraud? This paper tackles the tangled issue of healthcare waste and arrives at some interesting, and perhaps even surprising, conclusions: America!s healthcare system is, indeed, hemorrhaging billions of dollars, and the opportunities to slow the "scal bleeding are substantial. 4 Where can $700 billion in waste be cut annually? * O U I J T X I J U F Q B Q F S \r X F Q S F T F O U F W J E F O D F U I B U T V Q Q P S U T U I F S F B T P O B C M F O F T T P G U I F T F D M B J N T 5 I J T F W J E F O D F I B T C F F O H B U I F S F E G S P N Q V C M J T I F E S F T F B S D I T U V E J F T \r F Y Q F S U P Q J O J P O \r B O E ¾ O E J O H T G S P N P V S P X O 5 I P N T P O 3 F V U F S T B O B M Z T F T P G P V S M B S H F I F B M U I D B S F E B U B C B T F T 8 F E F T D S J C F U I F U Z Q F T P G X B T U F U I B U B S F S F D P H O
2 J [ F E C Z N P T U F Y Q F S U T
J [ F E C Z N P T U F Y Q F S U T B M P O H X J U I F T U J N B U F T P G U I F N B H O J U V E F P G U I B U X B T U F * O N P T U D B T F T \r F B D I S F G F S F O D F E S F T F B S D I T U V E Z G P D V T F T P O B T Q F D J ¾ D U Z Q F P S J O T U B O D F P G X B T U F 8 F T V H H F T U U I B U E J G G F S F O U J B U J O H B O E D I B S B D U F S J [ J O H U I F U Z Q F T P G X B T U F G B D J M J U B U F T U I F T F B S D I G P S B O E U I F F M J N J O B U J P O P G T Q F D J ¾ D X B T U F C Z I F B M U I D B S F Q S P W J E F S T B O E U I P T F P S H B O J [ B U J P O T U I B U B S F S F T Q P O T J C M F G P S Q B Z J O H G P S U I F T F T F S W J D F T 5 I F F G G P S U T U P N F B T V S F X B T U F B S F C B T F E P O U I F Q S F N J T F U I B U J U N B Z C F Q S F N B U V S F U P E F T D S J C F B I J H I M Z F G ¾ D J F O U I F B M U I D B S F T Z T U F N \r C V U U I F F W J E F O D F G P S X B T U F J T B C V O E B O U WHY IDENTIFY !WASTE" IN THE U.S. HEALTHCARE SYSTEM? * U J T B D P N N P O Q F S D F Q U J P O U I B U I F B M U I D B S F D P T U T J O U I F 6 O J U F E 4 U B U F T B S F ² U P P I J H I ³ 8 I F O D P N Q B S F E U P I F B M U I D B S F T Q F O E J O H C Z P U I F S E F W F M P Q F E D P V O U S J F T \r J U µ T F B T Z U P T F F X I B U J T E S J W J O H U I J T Q F S D F Q U J P O 5 I F 6 4 T Q F O E T N P S F Q F S D B Q J U B \r B O E U I F I J H I F T U Q F S D F O U B H F P G ( % 1 \r P O I F B M U I D B S F U I B O B O Z P U I F S 0 & $ % D P V O U S Z B T S F Q P S U F E J O U I F . B S D I \r ² 5 S F O E T J O ) F B M U I D B S F $ P T U T B O E 4 Q F O E J O H ³ C Z , B J T F S ' B N J M Z ' P V O E B U J P O 5 I F Z B M T P S F Q P S U F E U I B U ² 5 I F 6 O J U F E 4 U B U F T E F W P U F T D P O T J E F S B C M Z N P S F P G J U T F D P O P N Z U P I F B M U I D B S F U I B O P U I F S E F W F M P Q F E D P V O U S J F T ³ 1015 20 United States 15.3%10.0%11.0%10.6%8.1%8.4%11.3% CanadaFrance Germany Japan United KingdomSwitzerland ) F B M U I D B S F 4 Q F O E J O H 4 I B S F P G ( % 1 J O Source: Kaiser Family Foundation, Trends in Healthcare Costs and Spending, March 2009. Where can $700 billion in waste be cut annually? 5 5 I F ' P V O E B U J P O G V S U I F S S F Q P S U F E \r ² 6 4 \n I F B M U I D B S F T Q F O E J O H I B T S J T F O B C P V U Q F S D F O U B H F Q P J O U T G B T U F S U I B O ( % 1 T J O D F ³ / P U P O M Z E P F T D V S S F O U T Q F O E J O H P O I F B M U I D B S F D P O T V N F B I J H I Q F S D F O U B H F P G ( % 1 \r C V U U I F Q F S D F O U B H F J T F Y Q F D U F E U P D P O U J O V F S J T J O H $ P O U J O V J O H H S P X U I J O H P W F S O N F O U T Q F O E J O H G P S I F B M U I D B S F J T F Y Q F D U F E U P M F B E U P Q S P H S B N D P T U T \r T V D I B T U I F D P T U U P S V O . F E J D B S F \r U I B U F Y D F F E U I F O B U J P O µ T D B Q B D J U Z U P Q B Z 5 I F H P W F S O N F O U J T O P U U I F P O M Z F O U J U Z E F B M J O H X J U I U I F I J H I D P T U P G I F B M U I D B S F * U D P T U T 6 4 F N Q M P Z F S T T V C T U B O U J B M M Z N P S F U P Q S P W J E F I F B M U I D B S F G P S F N Q M P Z F F T \r U I F J S G B N J M J F T \r B O E S F U J S F F T U I B O U I F J S G P S F J H O D P N Q F U J U P S T ( F O F S B M . P U P S T \r G P S F Y B N Q M F \r T Q F O U
3 C J M M J P O J O P O I
C J M M J P O J O P O I F B M U I D B S F 5 I J T J T T J H O J ¾ D B O U M Z N P S F U I B O U I F Z T Q F O U G P S T U F F M B O E B D D P V O U F E G P S \r P G U I F Q S J D F P G F B D I O F X D B S J U Q S P E V D F E 5 P S F N B J O D P N Q F U J U J W F \r F N Q M P Z F S T B S F Q B T T J O H B T I B S F P G U I F C V S E F O U P F N Q M P Z F F T \r N B L J O H D P O T V N F S T B M T P G F F M B E J S F D U J N Q B D U P G U I F J O D S F B T J O H D P T U P G I F B M U I D B S F ± B U S F O E U I B U J T F Y Q F D U F E U P D P O U J O V F 4 P \r X I B U J T B S F B T P O B C M F D P T U G P S I F B M U I D B S F 6 O M J L F D P O T V N F S N B S L F U T G P S H P P E T T V D I B T B V U P N P C J M F T P S Q F S T P O B M F M F D U S P O J D T \r X I F S F N B S L F U T V Q Q M Z B O E E F N B O E E F U F S N J O F U I F ² S J H I U ³ Q S J D F \r U I F D P N Q M J D B U F E N B S L F U G P S I F B M U I D B S F E P F T O µ U ¾ U O J D F M Z X J U I J O U I F T F O B U V S B M N B S L F U S F H V M B U P S T * O B E E J U J P O U P U I F V O V T V B M S F M B U J P O T I J Q T J O I F B M U I D B S F C F U X F F O D P O T V N F S T \r Q B Z F S T \r B O E Q S P W J E F S T \r U I F F U I J D B M J N Q M J D B U J P O T J O W P M W F E J O I F B M U I D B S F E F D J T J P O T N B L F J U O F B S M Z J N Q P T T J C M F U P E F ¾ O F U I F ² S J H I U ³ B N P V O U U P T Q F O E P O I F B M U I D B S F " T U I F H P W F S O N F O U \r F N Q M P Z F S T \r B O E J O E J W J E V B M D J U J [ F O T E F C B U F X I B U J T B O B Q Q S P Q S J B U F B N P V O U U P T Q F O E P O I F B M U I D B S F \r U I F S F J T N V D I U I B U D B O C F E P O F U P S F E V D F I F B M U I D B S F D P T U T C Z F M J N J O B U J O H X B T U F B O E V O O F D F T T B S Z F Y Q F O E J U V S F T D B V T F E C Z . F E J D B M F S S P S T ' S B V E B O E B C V T F 1 B Z N F O U T G P S T F S W J D F T X J U I O P F W J E F O D F U I B U U I F Z D P O U S J C V U F U P C F U U F S I F B M U I P V U D P N F T * O F G ¾ D J F O D J F T J O U I F Q S P E V D U J P O P G I F B M U I D B S F H P P E T B O E T F S W J D F T \r J O D M V E J O H U I F D P T U P G F Y D F T T J W F F S S P S T 6 Where can $700 billion in waste be cut annually? HEALTHCARE WASTE DEFINED # F G P S F V O E F S U B L J O H B E J T D V T T J P O P G I F B M U I D B S F D P T U T B O E U I F P Q Q P S U V O J U J F T U P D P O U S P M U I F N C F U U F S \r J U J T J N Q P S U B O U U P V O E F S T U B O E B G F X U F S N T J O U I F D P O U F Y U P G U I F E J T D V T T J P O Cost containment: 5 I J T U F S N U Z Q J D B M M Z S F G F S T U P F G G P S U T U P D P O U S P M U I F I J H I S B U F P G J O D S F B T F J O U P U B M D P T U T P S ² C F O E J O H U I F D V S W F ³ " M U I P V H I N P T U P G U I F F G G P S U T B S F D P O T J T U F O U X J U I B H P B M P G F M J N J O B U J O H X B T U F \r B T J N Q M F P C K F D U J W F U P D V U P S D P O U B J O D P T U T D P V M E S F T V M U J O D P O T U S B J O J O H Q B U J F O U B D D F T T U P W B M V B C M F T F S W J D F T * U J T U I J T D P O D F S O U I B U M F B E T T P N F Q F P Q M F U P M J O L D P T U D P O U B J O N F O U X J U I U I F N P S F D P O U S P W F S T J B M U F S N ² S B U J P O J O H ³ Rationing: 8 I F O U I F O F F E G P S I F B
4 M U I D B S F T F S W J D F T F Y D
M U I D B S F T F S W J D F T F Y D F F E T B ¾ Y F E M F W F M P G B W B J M B C M F S F T P V S D F T \r E F D J T J P O T N V T U C F N B E F P O U I F S F M B U J W F N F S J U P G T Q F D J ¾ D Q B U J F O U O F F E 5 I F S F T V M U J T U I B U T P N F Q B U J F O U T X J M M O P U S F D F J W F T P N F T F S W J D F T 5 I F D P O D F Q U P G S B U J P O J O H S B J T F T T J H O J ¾ D B O U D P O D F S O T U I B U B ¾ Y F E M F W F M P G S F T P V S D F T X J M M C F B S C J U S B S J M Z E F U F S N J O F E B U B M F W F M X F M M C F M P X X I B U J T U S V M Z O F F E F E G P S I J H I R V B M J U Z \r B D D F T T J C M F I F B M U I D B S F " N P S F F Y U S F N F D P O D F S O J T U I B U E F U F S N J O B U J P O T P G S F M B U J W F O F F E X J M M C F N B E F C B T F E P O T Q F D J ¾ D Q B U J F O U D I B S B D U F S J T U J D T \r T V D I B T B H F Misuse, Overuse, and Underuse: 5 I F T F U F S N T S F G F S U P Q B U U F S O T P G N F E J D B M Q S B D U J D F B O E T F S W J D F T V T F U I B U E J S F D U M Z P S J O E J S F D U M Z B E E U P I F B M U I D B S F D P T U T 5 I F D P T U P G B T F S W J D F V T F E J O B Q Q S P Q S J B U F M Z N J T V T F \n B O E V T F P G B T F S W J D F X I F S F \r U I P V H I B Q Q S P Q S J B U F J O T P N F T J U V B U J P O T J T O P U F Y Q F D U F E U P Q S P W J E F W B M V F G P S B T Q F D J ¾ D Q B U J F O U P W F S V T F \n \r B E E C P U I E J S F D U D P T U T B O E Q P U F O U J B M D P T U T B T T P D J B U F E X J U I B D P N Q M J D B U J P O P G U I F Q S P D F E V S F 5 I F G B J M V S F U P E J B H O P T F B D P O E J U J P O J O B O F B S M Z T U B H F P S U P Q S F W F O U B O F Y J T U J O H D P O E J U J P O G S P N C F D P N J O H N P S F T F W F S F P S E F W F M P Q J O H D P N Q M J D B U J P O T D B O S F T V M U G S P N B G B J M V S F U P Q S P W J E F Q S F W F O U J W F B O E N B J O U F O B O D F D B S F V O E F S V T F \n * O U I J T D B T F \r Q S P W J E J O H U I F T F S W J D F T X P V M E B E E U P U I F T I P S U U F S N D P T U T C V U D P V M E Q S F W F O U U I F T J H O J ¾ D B O U M P O H U F S N D P T U T P G U S F B U J O H B N P S F T F W F S F D P O E J U J P O 6 O E F S V T F I B T C F F O P C T F S W F E J O V O E F S T F S W F E B S F B T X I F S F M B D L P G B D D F T T U P D B S F S F T V M U T J O V O O F D F T T B S Z D P N Q M J D B U J P O T P S Q P P S P V U D P N F T The New England Healthcare Institute (NEHI) has de!ned waste in healthcare as "Healthcare spending that can be eliminated without reducing the quality of care.# Where can $700 billion in waste be cut annually? 7 Unwarranted or unexplained variation in care: 5 I J T U F S N S F G F S T U P U I F P C T F S W F E W B S J B U J P O B D S P T T H F P H S B Q I J D S F H J P O T J O U I F V T F P G T Q F D J ¾ D Q S P D F E V S F T U I B U S F T V M U J O O P E J T D F S O J C M F E J G G F S F O D F T J O I F B M U I P V U D P N F T " M U I P V H I J U J T O P U Q P T T J C M F U P E F U F S N J O F B O B Q Q S P Q S J B U F S B U F G P S U I F T F Q S P D F E V S F T \r J U J T J O G F S S F E U I B U C F D B V T F U I F F W J E F O D F P O U I F B D U V B M F G G F D U J W F O F T T P G U I F T F Q S P D F E V S F T J T B N C J H V P V T \r U I P T F S F H J P O T X J U I I J H I V T F S B U F T B S F ² P W F S V U J M J [ J O H ³ U I F Q S
5 P D F E V S F B O E B E E J O H V
P D F E V S F B O E B E E J O H V O O F D F T T B S Z D P T U T Fraud and abuse: " T J U V B U J P O J O X I J D I I F B M U I D B S F J T Q B J E G P S \r C V U O P U Q S P W J E F E \r P S B T J U V B U J P O J O X I J D I S F J N C V S T F N F O U D M B J N T B S F N B E F U P U I J S E Q B S U Z J O T V S B O D F D P N Q B O J F T P S G F E F S B M Q S P H S B N T T V D I B T . F E J D B S F P S . F E J D B J E \r B O E O P T V D I T F S W J D F T X F S F S F O E F S F E ' S B V E B O E B C V T F B S F B M T P E F ¾ O F E B T I F B M U I D B S F Q S P W J E F S T S F D F J W J O H L J D L C B D L T \r Q B U J F O U T T F F L J O H U S F B U N F O U T U I B U B S F Q P U F O U J B M M Z I B S N G V M U P U I F N T V D I B T T F F L J O H E S V H T U P T B U J T G Z B E E J D U J P O T \n \r B O E U I F Q S F T D S J Q U J P O P G T F S W J D F T L O P X O U P C F V O O F D F T T B S Z 5 I F E F ¾ O J U J P O X F V T F G P S U I J T Q B Q F S J T G S P N 5 I F / F X & O H M B O E ) F B M U I D B S F * O T U J U V U F / & ) * \n X I J D I I B T E F ¾ O F E X B T U F J O I F B M U I D B S F B T !Healthcare spending that can be eliminated without reducing the quality of care." * U J T J N Q P S U B O U U P O P U F U I B U N P T U P G U I F X B T U F O P U P O M Z S F Q S F T F O U T B O V O O F D F T T B S Z D P T U \r C V U D B O B M T P S F T V M U J O B O J O D S F B T F E S J T L P G Q I Z T J D B M T V G G F S J O H P S I B S N F H \r V O O F D F T T B S Z T V S H J D B M Q S P D F E V S F \r X J U I S J T L P G D P N Q M J D B U J P O T P S E F B U I \n 5 I J T E F ¾ O J U J P O J O D M V E F T X B T U F E F ¾ O F E B T N J T V T F \r P W F S V T F \r B O E V O E F S V T F B O E X B T U F S F T V M U J O H G S P N V O X B S S B O U F E W B S J B U J P O 8 B T U F E F ¾ O F E J O U I J T X B Z Q S P W J E F T B U B S H F U G P S D P T U D P O U B J O N F O U F G G P S U T C V U E P F T O P U J O W P M W F B O Z M F W F M P G S B U J P O J O H \r T J O D F J U P O M Z B E E S F T T F T T F S W J D F T U I B U B S F O P U D P O T J E F S F E O F D F T T B S Z G P S R V B M J U Z Q B U J F O U D B S F B O E E P O P U D P O U S J C V U F U P P W F S B M M P V U D P N F T P G D B S F 5 I F S F G P S F \r B O F Y Q F O E J U V S F D M B T T J ¾ F E B T X B T U F B D D P S E J O H U P U I J T E F ¾ O J U J P O E P F T O P U D P O U S J C V U F U P 5 I F R V B M J U Z P G I F B M U I D B S F T F S W J D F T 5 I F P V U D P N F T P G D B S F 5 I F I F B M U I T U B U V T P G U I F Q P Q V M B U J P O 8 Where can $700 billion in waste be cut annually? HOW MUCH WASTE IS THERE IN HEALTHCARE? 5 P P S H B O J [ F U I F F W J E F O D F T V Q Q P S U J O H D M B J N T G P S U I F N B H O J U V E F P G X B T U F J O U I F I F B M U I D B S F T Z T U F N \r X F ¾ S T U T V H H F T U B T F U P G D B U F H P S J F T P G X B T U F ' P S F B D I D B U F H P S Z \r U I F S F J T B T J N Q M F E F ¾ O J U J P O \r B C S J F G E F T D S J Q U J P O P G U I F F Y B N Q M F T \r B O E S F G F S F O D F T U I B U B M M P X V T U P N B L F B S F B T P O B C M F B T T F T T N F O U P G U P U B M B O O V B M X B T U F G P S F B D I D B U F H P S Z $ B U F H P S Z S F T V M U T B S F U I F O B H H S F H B U F E U P F T U J N B U F B S F B T P O B C M F S B O H F G P S U P U B M B O O V B M I F B M U I D B S F T Z T U F N X B T U F
6 CATEGORIES OF HEALTHCARE WASTE # F O
CATEGORIES OF HEALTHCARE WASTE # F O U M F Z \r F U B M17 E J T D V T T U I S F F U Z Q F T P G X B T U F B E N J O J T U S B U J W F \r P Q F S B U J P O B M \r B O E D M J O J D B M 5 I F Z B M T P D P O T J E F S T Q F D J ¾ D F Y B N Q M F T P G X B T U F J O F B D I D B U F H P S Z B O E U I F F T U J N B U F E W B M V F P G U I B U X B T U F # B T F E P O P V S P X O S F T F B S D I \r J O B E E J U J P O U P B S F W J F X P G P U I F S Q V C M J T I F E M J U F S B U V S F \r X F G F F M J U J T N P S F V T F G V M U P S F W J F X X B T U F J O T J Y D B U F H P S J F T ' P S F B D I P G P V S D B U F H P S J F T P G X B T U F ± " E N J O J T U S B U J W F 4 Z T U F N * O F G ¾ D J F O D J F T \r 1 S P W J E F S * O F G ¾ D J F O D Z B O E & S S P S T \r - B D L P G $ B S F $ P P S E J O B U J P O \r 6 O X B S S B O U F E 6 T F \r 1 S F W F O U B C M F $ P O E J U J P O T B O E " W P J E B C M F $ B S F \r B O E ' S B V E B O E " C V T F ± X F S F W J F X F E ¾ O E J O H T G S P N P V S P X O B O B M Z T F T P G P V S Q S P Q S J F U B S Z I F B M U I D B S F E B U B C B T F T \r B O E T Z O U I F T J [ F E U I F S F T V M U T P G S F D F O U Q V C M J T I F E T U V E J F T B O E F Y Q F S U P Q J O J P O 5 I F S F T V M U J T B O F T U J N B U F E S B O H F G P S U I F U P U B M W B M V F P G Q P T T J C M F X B T U F J O U I B U D B U F H P S Z " O V O E F S T U B O E J O H P G U I F H F O F S B M N B H O J U V E F P G U I F W B S J P V T U Z Q F T P G X B T U F T I P V M E I F M Q U P Q S J P S J U J [ F B O E G P D V T F G G P S U T U P J N Q S P W F T Z T U F N F G ¾ D J F O D Z 8 F X P V M E M J L F U P B D L O P X M F E H F U I F X P S L P G U I F / F X & O H M B O E ) F B M U I D B S F * O T U J U V U F \r Q S F T F O U F E J O ² 8 B T U F B O E & G ¾ D J F O D Z J O U I F 6 4 ) F B M U I D B S F 4 Z T U F N ³ B T Q S P W J E J O H W B M V B C M F J O T J H I U P O T F W F S B M P G U I F D B U F H P S J F T $ J U B U J P O T G P S B M M R V P U F E S F G F S F O D F T \r J O D M V E J O H U I J T E P D V N F O U \r B S F J O D M V E F E J O U I F S F G F S F O D F T Where can $700 billion in waste be cut annually? 9 Evidence supporting the existence of administrative system inef!ciencies is extensive: ² 5 I F B W F S B H F 6 4 I P T Q J U B M T Q F O E T P O F R V B S U F S P G J U T C V E H F U P O C J M M J O H B O E B E N J O J T U S B U J P O \r O F B S M Z U X J D F U I F B W F S B H F J O $ B O B E B " N F S J D B O Q I Z T J D J B O T T Q F O E O F B S M Z F J H I U I P V S T Q F S X F F L P O Q B Q F S X P S L B O E F N Q M P Z D M F S J D B M X P S L F S T Q F S E P D U P S \r G B S N P S F U I B O J O $ B O B E B ³ ² * O \r I F B M U I B E N J O J T U S B U J P O D P T U T U P U B M F E B U M F B T U C J M M J P O J O U I F 6 O J U F E 4 U B U F T \r P S \r Q F S D B Q J U B \r B T D P N Q B S F E X J U I Q F S D B Q J U B J O $ B O B E B " G U F S F Y D M V T J P O T \r B E N J O J T U S B U J P O B D D P V O U F E G P S Q F S D F O U P G I F B M U I D B S F F Y Q F O E J U V S F T J O U I F 6 O J U F E 4 U B U F T B O E Q F S D F O U P G I F B M U I D B S F F Y Q F O E J U V S F T J O $ B O B E B ³ / P U F " S F E V D U J P O G S P N U P Q F S D F O U X P V M E T B W F $126 billion B O O V B M M Z ² 5 I J T
7 J T T V F C S J F G F Y B N J O F T
J T T V F C S J F G F Y B N J O F T U I F T P V S D F T P G B E N J O J T U S B U J W F D P T U T B O E E F T D S J C F T I P X B Q S J W B U F Q V C M J D B Q Q S P B D I U P I F B M U I D B S F S F G P S N ± X J U I U I F D F O U S B M G F B U V S F P G B O B U J P O B M J O T V S B O D F F Y D I B O H F M B S H F M Z S F Q M B D J O H U I F Q S F T F O U J O E J W J E V B M B O E T N B M M H S P V Q N B S L F U T \n ± D P V M E T V C T U B O U J B M M Z M P X F S T V D I D P T U T * O U I S F F W B S J B U J P O T P O U I B U B Q Q S P B D I \r F T U J N B U F E B E N J O J T U S B U J W F D P T U T X P V M E G B M M G S P N Q F S D F O U P G D M B J N T U P B O B W F S B H F P G Q F S D F O U 4 B W J O H T ± B T N V D I B T $265 billion over 2010"2020 ± X P V M E C F S F B M J [ F E U I S P V H I M F T T N B S L F U J O H B O E V O E F S X S J U J O H \r S F E V D F E D P T U T P G D M B J N T B E N J O J T U S B U J P O \r M F T T U J N F T Q F O U O F H P U J B U J O H Q S P W J E F S Q B Z N F O U S B U F T \r B O E G F X F S P S T U B O E B S E J [ F E D P N N J T T J P O T U P J O T V S B O D F C S P L F S T ³ 5 I F 1 S J D F X B U F S I P V T F $ P P Q F S T µ ) F B M U I 3 F T F B S D I * O T U J U V U F F T U J N B U F E P Q F S B U J P O X B T U F U P C F $126 to $315 billion Q F S Z F B S \r X J U I X B T U F J O U I F D M B J N T Q S P D F T T J O H B M P O F B U U P C J M M J P O ² 8 I F O U J N F J T D P O W F S U F E U P E P M M B S T \r X F F T U J N B U F U I B U U I F O B U J P O B M U J N F D P T U U P Q S B D U J D F T P G J O U F S B D U J P O T X J U I Q M B O T J T B U M F B T U $23 billion to $31 billion F B D I Z F B S ³10 ² ) F B M U I B E N J O J T U S B U J P O D P T U T S F Q S F T F O U $91 billion \r P S Q F S D F O U P G U P U B M T Q F O E J O H B C P W F F Y Q F D U F E \r E V F Q B S U M Z U P U I F T Z T U F N T U S V D U V S F \r C V U B M T P P O B D D P V O U P G J O F G ¾ D J F O D J F T B O E S F E V O E B O D J F T U I B U F Y J T U X J U I J O U I F T Z T U F N ³11 ADMINISTRATIVE SYSTEM INEFFICIENCIESReasonable Range For Annual Waste: $100!$150 Billion " M M P S H B O J [ B U J P O T \r B D S P T T B M M J O E V T U S J F T \r I B W F J O F G ¾ D J F O U B E N J O J T U S B U J W F Q S P D F T T F T ) P X F W F S \r J O I F B M U I D B S F \r U I F T F S J P V T G S B H N F O U B U J P O P G Q S P W J E F S T \r U I F M B S H F O V N C F S P G Q B Z F S T \r B O E S F T V M U J O H E J T Q B S B U F T Z T U F N T B O E Q S P D F E V S F T T J H O J ¾ D B O U M Z B E E U P Q S P W J E F S B O E Q B Z F S B E N J O J T U S B U J W F D P T U T ) F B M U I D B S F Q S P W J E F S T N V T U E F B M X J U I E P [ F O T P G I F B M U I B O E C F O F ¾ U Q M B O T U P C J M M T V D D F T T G V M M Z G P S T F S W J D F T S F O E F S F E ) F B M U I Q M B O T N V T U T V Q Q P S U T Z T U F N T G P S V O E F S X S J U J O H \r D M B J N T B E N J O J T U S B U J P O \r Q S P W J E F S O F U X P S L D P O U S B D U J O H \r B O E C S P L F S O F U X P S L N B O B H F N F O U " D D P S E J O H U P B Q P T J U J P O Q B Q F S C Z U I F . F E J D B M ( S P V Q . B O B H F N F O U " T T P D J B U J P O \r ² 4 J N Q M J G Z J O H P V S I F B M U I D B S F T Z T U F N µ T B E N J O J T U S B U J P O D P V M E S F E V D F B O O V B M I F B M U I D B S F D P T U T C Z B M N P T U C J M M J P O ³ 10
8 Where can $700 billion in waste be cut
Where can $700 billion in waste be cut annually? PROVIDER INEFFICIENCY AND ERRORS Reasonable Range for Annual Waste: $75!$100 Billion * O F G ¾ D J F O D J F T J O U I F D B S F E F M J W F S Z Q S P D F T T F T P G J O E J W J E V B M Q S P W J E F S T S F T V M U J O T J H O J ¾ D B O U X B T U F . B O Z Q S P W J E F S Q S P D F T T J O F G ¾ D J F O D J F T B S F T J N J M B S U P U I P T F F Y Q F S J F O D F E J O P U I F S U Z Q F T P G P S H B O J [ B U J P O T \r T V D I B T S F T P V S D F T D I F E V M J O H B Q Q S P Q S J B U F N J Y P G H F O F S B M M P X F S D P T U B O E T Q F D J B M J [ F E I J H I F S D P T U S F T P V S D F T G B D J M J U Z P S F R V J Q N F O U V U J M J [ B U J P O P S U I S P V H I Q V U B O E U J N J O H B O E D P P S E J O B U J P O P G N V M U J Q M F Q S P D F E V S F T G P S B T J O H M F Q B U J F O U U P N J O J N J [ F E P X O U J N F % P D V N F O U F E F Y B N Q M F T P G U I F T F U Z Q F T P G J O F G ¾ D J F O D J F T J O D M V E F * O F G ¾ D J F O U V T F P G Q S P G F T T J P O B M T U B G G F Y U F O E F S T T V D I B T O V S T F Q S B D U J U J P O F S T B O E Q I Z T J D J B O B T T J T U B O U T * O F G ¾ D J F O U V T F P G G B D J M J U J F T B O E F R V J Q N F O U \r T V D I B T M P X V U J M J [ B U J P O P G F Y Q F O T J W F J N B H J O H F R V J Q N F O U B O E J O F G ¾ D J F O U T D I F E V M J O H P G P Q F S B U J O H S P P N T B O E U F B N T 6 O O F D F T T B S Z P O F E B Z I P T Q J U B M B E N J T T J P O T F H \r G P S P C T F S W B U J P O P S S P V U J O F U F T U J O H \n B O E F Y U F O E F E T U B Z T 0 W F S V U J M J [ B U J P O P G U F T U J O H F H \r M B C \r J N B H J O H \n G P S I P T Q J U B M J [ F E Q B U J F O U T 0 W F S V U J M J [ B U J P O P G J O U F O T J W F D B S F V O J U T " 4 F Q U F N C F S 5 I P N T P O 3 F V U F S T 3 F T F B S D I # S J F G S F Q P S U T \r ² 5 I F S F B S F F O P S N P V T E J G G F S F O D F T C F U X F F O U I F C F O D I N B S L B O E U I F X P S T U I P T Q J U B M T P O P Q F S B U J P O B M F G ¾ D J F O D Z N F B T V S F T ³12 5 I F S F Q P S U D P N Q B S F T I P T Q J U B M T P O N F B T V S F T P G C P U I P Q F S B U J P O B M F G ¾ D J F O D Z B O E D M J O J D B M R V B M J U Z B O E D P O D M V E F T U I B U B D I J F W J O H C F O D I N B S L P Q F S B U J P O B M Q F S G P S N B O D F E P F T O P U U I S F B U F O D M J O J D B M R V B M J U Z & G G P S U T U P J N Q S P W F P Q F S B U J P O B M F G ¾ D J F O D Z J O W P M W F J N Q S P W J O H Q S P D F T T F T \r O P U N F S F M Z D P T U D V U U J O H 5 I F S F Q P S U P G G F S T U I B U ² & G ¾ D J F O U M Z E F T J H O F E X P S L ¿ P X \r I B O E P G G T \r B O E P U I F S Q S P D F E V S F T D B O F O I B O D F P Q F S B U J P O T X I J M F T J N V M U B O F P V T M Z J N Q S P W J O H D M J O J D B M R V B M J U Z ³A special type of provider inef!ciency is avoidable errors . P T U P S H B O J [ B U J P O T S F D P H O J [ F B W P J E B C M F F S S P S T B T X B T U F B O E B U U F N Q U U P N J O J N J [ F U I F N * O I F B M U I D B S F \r U I F J N Q B D U P G F S S P S T H P F T G B S C F Z P O E ¾ O B O D J B M J N Q M J D B U J P O T \r X J U I F S S P S T S F T V M U J O H J O D P N Q M J D B U J P O T \r S F B E N J T T J P O T \r B E E J U J P O B M Q B J O G V M Q S P D F E V S F T \r E J T B C J M J U Z ± P S F W F O E F B U I ' P S U I J T S F B T P O \r U I F
9 D P O W J O D J O H F W J E F O D F
D P O W J O D J O H F W J E F O D F G P S V O B D D F Q U B C M Z I J H I S B U F T P G F S S P S Q S F T F O U F E J O U I F M J U F S B U V S F J T B N B K P S D P O D F S O * O B E E J U J P O U P S F D P H O J [ J O H U I F I V N B O D P T U T P G U I F T F F S S P S T \r U I F M J U F S B U V S F B M T P B U U F N Q U T U P E F T D S J C F B O E F T U J N B U F U I F ¾ O B O D J B M D P T U P G S F M B U F E F Y D F T T N F E J D B M T F S W J D F T 4 F W F S B M U Z Q F T P G E P D V N F O U F E D P T U T J O D M V E F & Y U F O E F E I P T Q J U B M T U B Z U P U S F B U B W P J E B C M F D P N Q M J D B U J P O T P S Q S P D F E V S F S F M B U F E J O K V S J F T 3 F B E N J T T J P O U P U I F I P T Q J U B M T I P S U M Z G P M M P X J O H E J T D I B S H F U P S F T Q P O E U P B O B W P J E B C M F F T D B M B U J P O P G B D P O E J U J P O P S D P N Q M J D B U J P O " D V U F D B S F S F R V J S F E U P U S F B U B D P N Q M J D B U J P O S F T V M U J O H G S P N F S S P S T N B E F E V S J O H B O P V U Q B U J F O U Q S P D F E V S F 5 S F B U N F O U G P S B E W F S T F E S V H F G G F D U T \r J O D M V E J O H E S V H E S V H J O U F S B D U J P O T B O E B W P J E B C M F S F B D U J P O T Where can $700 billion in waste be cut annually? 11 Considerable evidence supports the extent of waste from provider inef!ciency and errors in healthcare, including the following: 5 I P N T P O 3 F V U F S T I B T D P N Q M F U F E U X P T U V E J F T F T U J N B U J O H U I F Q P U F O U J B M T B W J O H T G S P N J N Q S P W F N F O U J O I P T Q J U B M P Q F S B U J O H F G ¾ D J F O D Z # P U I T U V E J F T D P N Q B S F E O B U J P O B M I P T Q J U B M Q F S G P S N B O D F U P B T F U P G I J H I Q F S G P S N J O H I P T Q J U B M C F O D I N B S L T B W B J M B C M F J O P V S " $ 5 * 0 / 0 * B O E 5 P Q ) P T Q J U B M T E B U B * O U I F ¾ S T U T U V E Z \r J G B M M I P T Q J U B M T F Y Q F S J F O D F E U I F M P X F S S B U F P G F Y Q F O T F J O ¿ B U J P O F Y Q F S J F O D F E C Z U I F Thomson Reuters 100 Top Hospitals \r O B U J P O B M I P T Q J U B M P Q F S B U J O H F Y Q F O T F T X P V M E C F S F E V D F E C Z $32 billion Q F S Z F B S B G U F S U I S F F Z F B S T * O U I F T F D P O E T U V E Z \r J G B M M I P T Q J U B M T S F E V D F E U I F J S B W F S B H F D P T U U P U I F B W F S B H F D P T U P G U I F N P T U F G ¾ D J F O U Q F S D F O U P G I P T Q J U B M T \r P Q F S B U J O H F Y Q F O T F T X P V M E C F S F E V D F E C Z $73 billion Q F S Z F B S 5 I F T F U X P T U V E J F T Q S P W J E F B D P O T J T U F O U F T U J N B U F P G U I F N B H O J U V E F P G U I J T X B T U F E V F U P P Q F S B U J P O B M J O F G ¾ D J F O D Z " O B O B M Z T J T P G U I F D P T U B T T P D J B U F E X J U I B E W F S T F T B G F U Z F W F O U T J O U I F 5 I P N T P O 3 F V U F S T 1 S P K F D U F E * O Q B U J F O U % B U B C B T F 1 * % # \n T V H H F T U T U I B U U I F U P U B M O B U J P O B M D P T U G P S U I F T F F W F O U T J T C J M M J P O ² 5 I F J N Q M F N F O U B U J P O P G B M B C P S B U P S Z U F T U T B O E D I F T U S B E J P H S B Q I T Q S F T D S J Q U J P O Q S P U P D P M X J U I J O P V S * $ 6 J O E V D F E B O J N Q P S U B O U D P T U T B W J O H ³ ² © S F E V D U J P O P G S P V U J O F M B C P S B U P S Z U F T U T Q F S G P S
10 N B O D F X B T P C T F S W F E Q
N B O D F X B T P C T F S W F E Q F S Q B U J F O U * $ 6 E B Z \r S B O H J O H G S P N U P Q F S D F O U E F Q F O E J O H P O U I F U Z Q F P G U F T U ³ ² ' P S D I F T U S B E J P H S B Q I T \r B Q F S D F O U S F M B U J W F S F E V D U J P O X B T P C T F S W F E ³13 " M M U I F G P M M P X J O H R V P U B U J P O T U B L F O G S P N ² 8 B T U F B O E * O F G ¾ D J F O D Z J O U I F 6 4 ) F B M U I D B S F 4 Z T U F N \r $ M J O J D B M $ B S F " $ P N Q S F I F O T J W F " O B M Z T J T J O 4 V Q Q P S U P G 4 Z T U F N X J E F * N Q S P W F N F O U T \r ³ / F X & O H M B O E ) F B M U I D B S F * O T U J U V U F \r ' F C S V B S Z ² 5 B L F O U P H F U I F S \r B W P J E B C M F B E W F S T F U S F B U N F O U F W F O U T B O E I P T Q J U B M B D R V J S F E J O G F D U J P O T D P O T F S W B U J W F M Z S F T V M U J O B N J O J N V N P G $52.2 billion U I B U B S F X B T U F E F B D I Z F B S \r O P U U P N F O U J P O U I F I V N B O U P M M P G U I F T F B W P J E B C M F F W F O U T ³ ² " E W F S T F U S F B U N F O U F W F O U T B S F X F M M E P D V N F O U F E T P V S D F T P G X B T U F 4 U V E J F T G S P N ) B S W B S E . F E J D B M 4 D I P P M T V H H F T U U I B U B E W F S T F F W F O U T D P O T F S W B U J W F M Z B D D P V O U G P S Q F S D F O U P G U P U B M I F B M U I D B S F T Q F O E J O H \r P S $100 billion Q F S Z F B S E P M M B S T \n \r B O E U I B U almost half of all adverse events (46.5 percent) are avoidable. ² # F U X F F O ¾ W F B O E U F O Q F S D F O U P G B M M Q B U J F O U T B E N J U U F E U P B D V U F D B S F I P T Q J U B M T B D R V J S F P O F P S N P S F J O G F D U J P O T \r S F T V M U J O H J O B O F T U J N B U F E \r E F B U I T F B D I Z F B S B O E B O O V B M X B T U F U P U B M J O H B O F T U J N B U F E $4.5 to $5.7 billion per year ³ ² * O \r I P T Q J U B M T J O 1 F O O T Z M W B O J B S F Q P S U F E \r I P T Q J U B M B D R V J S F E J O G F D U J P O T P G U I F T F \r Q F S D F O U P G U I F Q B U J F O U T X I P B D R V J S F E U I F J O G F D U J P O E J F E 5 I F E J S F D U N F E J D B M D P T U B T T P D J B U F E X J U I U I P T F J O G F D U J P O T J O 1 F O O T Z M W B O J B X B T $2 billion ³ ² # F Z P O E U I F J S D P T U J O I V N B O M J W F T \r Q S F W F O U B C M F N F E J D B M F S S P S T F Y B D U P U I F S T J H O J ¾ D B O U U P M M T 5 I F Z I B W F C F F O F T U J N B U F E U P S F T V M U J O U P U B M D P T U T J O D M V E J O H U I F F Y Q F O T F P G B E E J U J P O B M D B S F O F D F T T J U B U F E C Z U I F F S S P S T \r M P T U J O D P N F \r B O E I P V T F I P M E Q S P E V D U J W J U Z \r B O E E J T B C J M J U Z \n P G C F U X F F O $17 billion and $29 billion Q F S Z F B S J O I P T Q J U B M T O B U J P O X J E F ³14 12 Where can $700 billion in waste be cut annually? How prevalent is lack of care coordination? The evidence reveals extensive waste: 3 P V H I M Z \r N F E J D B U J P O F S S P S T P D D V S B N P O H . F E J D B S F S F D J Q J F O U T J O P V U Q B U J F O U D M J O J D T L Q S F W F O U B C M F " % & J O K V S J F T B O E E F B U I T J O P V U Q B U J F O U Z F B S ³18 ² 0 V S F T U J N B U F T T V H H F T U U I B U F M J N J O B U J O H B W P J E B C M F & % N F S H F O D Z % F Q B S U N F O U&#x &1.;@è
11 V T F D P V M E T B W F B U M F
V T F D P V M E T B W F B U M F B T U $21.4 billion Q F S Z F B S P O B O B U J P O B M C B T J T J U D P V M E B M T P G S F F V Q F N F S H F O D Z E F Q B S U N F O U T U P U B L F D B S F P G U S V F F N F S H F O D J F T © ³ $ P T U G P S ² B W P J E B C M F I P T Q J U B M J [ B U J P O T P G O V S T J O H I P N F Q B U J F O U T ³ J T $7.5 billion B O O V B M M Z 17 ² 0 O F T U V E Z G P V O E U I B U F B D I Q S F W F O U B C M F " % & U I B U U P P L Q M B D F J O B I P T Q J U B M B E E F E B C P V U \r U P U I F D P T U P G U I F I P T Q J U B M T U B Z " T T V N J O H \r P G U I F T F F W F O U T F B D I Z F B S ± B D P O T F S W B U J W F F T U J N B U F ± U I F U P U B M B O O V B M D P T U X P V M E C F $3.5 billion J O U I J T P O F H S P V Q ³15 ² 1 P U F O U J B M M Z J O B Q Q S P Q S J B U F N F E J D B U J P O 1 * . \n V U J M J [ B U J P O J T B T J H O J ¾ D B O U Q S F E J D U P S G P S I J H I F S I F B M U I D B S F F Y Q F O E J U V S F T " D P O T F S W B U J W F F T U J N B U F P G U I F J O D S F N F O U B M I F B M U I D B S F F Y Q F O E J U V S F T S F M B U F E U P 1 * . V T F J O U I F D P N N V O J U Z E X F M M J O H F M E F S M Z Q P Q V M B U J P O X P V M E C F $7.2 billion J O U I F 6 O J U F E 4 U B U F T J O ³16 ² ' P S F Y B N Q M F \r N F E J D B M F S S P S T ± X I J D I D B O J O E J D B U F J O F G ¾ D J F O U Q S P D F T T F T ± B S F F T U J N B U F E U P D P T U C F U X F F O $17 billion and $29 billion B O O V B M M Z J O U I F 6 O J U F E 4 U B U F T © ³17 LACK OF CARE COORDINATIONReasonable Range for Annual Waste: $25!$50 Billion 8 I F O D B S F Q S P W J E F S T E P O P U D P P S E J O B U F U I F T F S W J D F T U I F Z Q S P W J E F \r T F W F S B M U Z Q F T P G J O F G ¾ D J F O D J F T P D D V S U I B U B S F C P U I D P T U M Z B O E Q P U F O U J B M M Z I B S N G V M U P Q B U J F O U T ' P S J O T U B O D F \r J U J T X B T U F X I F O D B S F H J W F S T E V Q M J D B U F U F T U T C F D B V T F S F T V M U T S F D P S E F E J O B Q B U J F O U µ T S F D P S E X J U I P O F Q S P W J E F S B S F O P U B W B J M B C M F U P B O P U I F S P S X I F O N F E J D B M T U B G G Q S P W J E F T J O B Q Q S P Q S J B U F U S F B U N F O U C F D B V T F S F M F W B O U I J T U P S Z P G Q S F W J P V T U S F B U N F O U D B O O P U C F B D D F T T F E * U J T B M T P X B T U F G V M X I F O Q B U J F O U T B S F G P S D F E U P V T F U I F F N F S H F O D Z S P P N G P S O P O F N F S H F O U D P O E J U J P O T C F D B V T F Q S J N B S Z D B S F T F S W J D F T B S F V O B W B J M B C M F + V T U B T V O O F D F T T B S Z J T P S E F S J O H B W P J E B C M F I P T Q J U B M J [ B U J P O T G P S O V S T J O H I P N F Q B U J F O U T ' J O B M M Z \r C P U I X B T U F G V M B O E Q P U F O U J B M M Z E B O H F S P V T B S F B E W F S T F E S V H S F B D U J P O T U I B U P D D V S X I F O B S F D P S E P G B Q B U J F O U µ T D V S S F O U N F E J D B U J P O T J T V O B W B J M B C M F Where can $700 billion in waste be cut annually? 13 UNWARRANTED USEReasonable Range For Annual Waste: $250!$325 Billion / F B S M Z B M M F Y Q F S U T B H S F F U I B U B T J H O J ¾ D B O U B N P V O U P G E J S F D U D B S F Q S P W J E F T O P P S P O M Z N B S H J O B M W B M V F U P F J U I F S U I F E J B H O P T J T P G B Q B U J F O U µ T D P O E J U J P O P
12 S F G G F D U J W F U S F B U N F O
S F G G F D U J W F U S F B U N F O U P G B E J B H O P T F E D P O E J U J P O 4 V D I D P T U T B S F V O O F D F T T B S Z U P I J H I R V B M J U Z \r F G G F D U J W F D M J O J D B M D B S F % B S U N P V U I µ T $ F O U F S G P S U I F & W B M V B U J W F $ M J O J D B M 4 D J F O D F T E F ¾ O F T U X P T Q F D J ¾ D D B U F H P S J F T P G V O O F D F T T B S Z D B S F ² Q S F G F S F O D F T F O T J U J W F ³ D B S F B O E ² T V Q Q M Z T F O T J U J W F ³ D B S F 5 I F Q S F W B M F O D F B O E N B H O J U V E F P G F B D I P G U I F T F D B U F H P S J F T P G V O O F D F T T B S Z D B S F J T E F N P O T U S B U F E C Z N F B T V S J O H U I F T J H O J ¾ D B O U W B S J B U J P O J O U I F V T F P G T Q F D J ¾ D Q S P D F E V S F T X J U I . F E J D B S F Q B U J F O U T J O E J G G F S F O U H F P H S B Q I J D S F H J P O T B O E I P T Q J U B M B S F B T 5 I F E J G G F S F O D F T J O V T F B S F O P U F Y Q M B J O F E C Z E J G G F S F O D F T J O U I F E F N P H S B Q I J D T P S S J T L Q S P ¾ M F T P G U I F Q P Q V M B U J P O T T F S W F E B O E E P O P U S F T V M U J O B O Z N F B T V S B C M F E J G G F S F O D F T J O D M J O J D B M P V U D P N F T 19 0 U I F S J O W F T U J H B U P S T B U U F N Q U U P N F B T V S F U I F J N Q B D U P G F Y D F T T J W F F Y Q P T V S F U P N F E J D B M M J B C J M J U Z D M B J N T B T B D B V T F P G P W F S V T F P G T F S W J D F T 5 I J T Q S B D U J D F J T S F G F S S F E U P B T ² E F G F O T J W F N F E J D J O F ³ & Y B N Q M F T P G U I J T V O X B S S B O U F E V T F P G T F S W J D F T J O D M V E F % J B H O P T U J D M B C P S J N B H J O H U F T U T Q F S G P S N F E U P Q S P U F D U B H B J O T U N B M Q S B D U J D F F Y Q P T V S F " T V S H J D B M Q S P D F E V S F X J U I B Q B U J F O U Q S F G F S S F E N F E J D B M U S F B U N F O U B M U F S O B U J W F % B S U N P V U I µ T ² Q S F G F S F O D F T F O T J U J W F D B S F ³ \n " I J H I D P T U E J B H O P T U J D Q S P D F E V S F V T F E G P S Q B U J F O U T B U M P X S J T L G P S U I F D P O E J U J P O " E J B H O P T U J D U F T U X J U I O P F Y Q F D U F E J N Q B D U P O U I F D P V S T F P G U S F B U N F O U 5 I F J O B Q Q S P Q S J B U F V T F P G B O B O U J C J P U J D G P S B O V Q Q F S S F T Q J S B U P S Z W J S B M J O G F D U J P O * O U F O T J W F O P O Q B M M J B U J W F F O E P G M J G F U S F B U N F O U % B S U N P V U I µ T ² T V Q Q M Z T F O T J U J W F D B S F ³ \n # S B O E O B N F E S V H Q S F T D S J C F E X I F O H F O F S J D P S U I F S B Q F V U J D B M U F S O B U J W F T B S F B W B J M B C M F ' B J M V S F U P G P M M P X D P O T F S W B U J W F U S F B U N F O U Q S P U P D P M P S G P M M P X B S F D P N N F O E F E D P V S T F P G T V D D F T T J W F U S F B U N F O U F T D B M B U J P OThe Thomson Reuters MarketScan Database provides signi!cant evidence in this category of healthcare waste. 5 I F 5 I P N T P O 3 F V U F S T . B S L F U 4 D B O D P N N F S D J B M E B U B C B T F J O D M V E F T D M B J N T E B U B G P S B M N P T U N J M M J P O Q F P Q M F 5 I F E B U B J T Q B S U J D V M B S M Z S F Q S F T F O U B U J W F P G U I F I F B M U I D B S F F Y Q F S J F O D F T P G F N Q M P Z F F T P G U I F M B S H F T U 6 4 F N Q M P Z F S T 5 I P N T P O 3 F V U F S T D B M D V M B U F E U I F D P T U T P G Q S P W J E J O H
13 T V S H J D B M Q S P D F E V S F
T V S H J D B M Q S P D F E V S F T U I B U B S F G S F R V F O U M Z J O D M V E F E J O M J T U T P G Q P U F O U J B M M Z P W F S V T F E Q S P D F E V S F T J O D M V E J O H D P S P O B S Z B S U F S Z C Z Q B T T H S B G U \r Q F S D V U B O F P V T D P S P O B S Z J O U F S W F O U J P O \r I J Q B O E L O F F S F Q M B D F N F O U \r $ F T B S F B O T F D U J P O \r I Z T U F S F D U P N Z \r U S B O T V S F U I S B M S F T F D U J P O P G U I F Q S P T U B U F \r E J T L T V S H F S Z B O E T Q J O B M G V T J P O \r B O E J N Q M B O U B C M F E F ¾ C S J M M B U P S T 8 F U I F O B Q Q M J F E U I J T S F T V M U U P F T U J N B U F U I F D P T U G P S U I F T F Q S P D F E V S F T G P S U I F F O U J S F D P N N F S D J B M M Z J O T V S F E Q P Q V M B U J P O 6 T J O H U I J T B Q Q S P B D I \r X F F T U J N B U F U I B U B Q Q S P Y J N B U F M Z C J M M J P O J T T Q F O U B O O V B M M Z C Z D P N N F S D J B M I F B M U I Q M B O T G P S U I F T F Q S P D F E V S F T * G F W F O B U I J S E P G U I F T F Q S P D F E V S F T J T V O O F D F T T B S Z \r U I J T X P V M E T V H H F T U X B T U F P G $10 billion " T J N J M B S B O B M Z T J T P G T F W F S B M D M B T T F T P G Q P U F O U J B M M Z P W F S V T F E Q S F T D S J Q U J P O E S V H T T V H H F T U F E B U P U B M 6 4 D P T U P G C J M M J P O \r B U I J S E P G X I J D I X P V M E J O E J D B U F X B T U F P G P W F S $4 billion 14 Where can $700 billion in waste be cut annually? The evidence of waste from unwarranted use of healthcare services comes from a number of sources: ² © D P T U T P G W B S J B U J P O C F U X F F O I J H I B O E M P X V U J M J [ J O H S F H J P O T B Q Q S P B D I F T Q F S D F O U P G U P U B M I F B M U I D B S F T Q F O E J O H ³ ² . P S F U I B O N J M M J P O I J H I U F D I T D B O T B S F E P O F F B D I Z F B S \r B O E N F E J D B M J N B H J O H \r J O D M V E J O H $ 5 \r . 3 * \r B O E 1 & 5 T D B O T \r I B T C B M M P P O F E J O U P B C J M M J P O B Z F B S J O E V T U S Z J O U I F 6 O J U F E 4 U B U F T \r X J U I . F E J D B S F Q B Z J O H G P S C J M M J P O P G U I B U # V U S F D F O U T U V E J F T T I P X U I B U B T N B O Z B T Q F S D F O U U P Q F S D F O U P G U I F Q S P D F E V S F T T I P V M E O F W F S I B W F C F F O E P O F C F D B V T F U I F J S S F T V M U T E J E O P U I F M Q E J B H O P T F B J M N F O U T P S U S F B U Q B U J F O U T ³20 ² " U P U B M P G Q I Z T J D J B O T Q F S D F O U \n D P N Q M F U F E U I F T V S W F Z / F B S M Z B M M Q F S D F O U \n S F Q P S U F E Q S B D U J D J O H E F G F O T J W F N F E J D J O F ´ " T T V S B O D F C F I B W J P S µ T V D I B T P S E F S J O H U F T U T \r Q F S G P S N J O H E J B H O P T U J D Q S P D F E V S F T \r B O E S F G F S S J O H Q B U J F O U T G P S D P O T V M U B U J P O \r X B T W F S Z D P N N P O Q F S D F O U \n " N P O H Q S B D U J U J P O F S T P G E F G F O T J W F N F E J D J O F X I P E F U B J M F E U I F J S N P T U S F D F O U E F G F O T J W F B D U \r Q F S D F O U S F Q P S U F E V T J O H J N B H J O H U F D I O P M P H Z J O D M J O J D B M M Z V O O F D F T T B S Z D J S D V N T U B O D F T ³21 ² 0 V S B O B M Z T J T P G Q F F S S F W J F X F E M J U F S B U V S F T I P X F E U I B U U I F S F J T T U S P O H F W J E F O D F U I B
14 U N P T U P G U I F B O U J C J
U N P T U P G U I F B O U J C J P U J D T Q S F T D S J C F E G P S U I F U S F B U N F O U P G U I F T F J O G F D U J P O T F B S J O G F D U J P O T \r T P S F U I S P B U \r V Q Q F S S F T Q J S B U P S Z J O G F D U J P O T \n B S F V O O F D F T T B S Z \r B T U I F T F D P N N P O J O G F D U J P O T B S F M B S H F M Z E V F U P W J S V T F T U I B U B S F O P U T V T D F Q U J C M F U P B O U J C J P U J D T 5 I F E B U B T V H H F T U T U I B U V Q U P Q F S D F O U P G B O U J C J P U J D Q S F T D S J Q U J P O T B S F N F E J D B M M Z V O O F D F T T B S Z B O E D P V M E C F B W P J E F E \r S F T V M U J O H J O B O O V B M T B W J O H T P G $1.1 billion. ² 5 B L F O U P H F U I F S \r U I F J S S F Q P S U T % B S U N P V U I . F E J D B M 4 D I P P M \n S F H B S E J O H W B S J B U J P O J O U I F J O U F O T J U Z P G B C S P B E S B O H F P G D M J O J D B M T F S W J D F T M F B E V T U P C F M J F W F U I B U U I F D P T U P G Q P U F O U J B M M Z B W P J E B C M F D M J O J D B M D B S F B Q Q S P Y J N B U F T Q F S D F O U P G U P U B M I F B M U I D B S F T Q F O E J O H * G U I J T F T U J N B U F J T D P S S F D U \r $600 billion E P M M B S T \n D P V M E C F T B W F E F B D I Z F B S C Z V O E F S T U B O E J O H B O E Q S F W F O U J O H V O F Y Q M B J O F E W B S J B U J P O T J O D B S F Q B U U F S O T ³ ² " D D P S E J O H U P B S F D F O U T U V E Z C Z U I F . D , J O T F Z ( M P C B M * O T U J U V U F \r E J B H O P T U J D J N B H J O H G S P N D P N Q V U F E U P N P H S B Q I Z $ 5 \n B O E N B H O F U J D S F T P O B O D F J N B H J O H . 3 * \n T D B O T D P O U S J C V U F $26.5 billion J O V O O F D F T T B S Z V T F P G I F B M U I T F S W J D F T ³22 ² . B O Z I Z Q F S U F O T J W F Q B U J F O U T D P V M E C F U S F B U F E X J U I J O F Y Q F O T J W F H F O F S J D N F E J D B U J P O T \r T V D I B T E J V S F U J D T B O E ¾ S T U H F O F S B U J P O C F U B C M P D L F S T \r S B U I F S U I B O N P S F F Y Q F O T J W F C S B O E F E B O U J I Z Q F S U F O T J W F T U I B U B S F U Z Q J D B M M Z Q S F T D S J C F E ³ 0 V S B O B M Z T F T P G U I F F W J E F O D F T V H H F T U U I B U B U M F B T U $3 billion D P V M E C F T B W F E F B D I Z F B S C Z T J N Q M Z N B L J O H M F T T F Y Q F O T J W F C V U F R V B M M Z F G G F D U J W F B O E T B G F N F E J D B U J P O D I P J D F T ³ Where can $700 billion in waste be cut annually? 15 ² - B C P S B U P S Z U F T U T B O E Q S P D F E V S F T O P U S F D P N N F O E F E % S B O L J O H \n J O D M V E F E V S J O B M Z T J T 6 " T \n J O U F S W F O U J P O T O P U S F D P N N F O E F E J O D M V E F E F M F D U S P D B S E J P H S B N T & , ( T \n B O E 9 S B Z T 3 & 4 6 - 5 4 5 I F G S F R V F O D Z P G P S E F S J O H B O Z P G U I F U I S F F E J B H O P T U J D J O U F S W F O U J P O T S B O H F E G S P N Q F S D F O U U P Q F S D F O U \r B O E B U M F B T U P O F P G U I F J O U F S W F O U J P O T X B T P S E F S F E Q F S D F O U P G U I F U J N F " O O V B M E J S F D U D P T U T G P S U I F U I S F F J O U F S W F O U J P O T S B O H F G S P N $47 million to $194 million ³23 ² " T V S W F Z J O U I F Journal of the American Medical Association S F M B U F E U I B U Q F S D F O U P G I J H I S J T L T Q F D J B M J T U T J O 1 F O O T Z M W B O J B B E N J U U F E U
15 P U I F Q S B D U J D F \r B O E
P U I F Q S B D U J D F \r B O E Q F S D F O U P G . B T T B D I V T F U U T Q I Z T J D J B O T E J E U I F T B N F J O B T V S W F Z 5 I F T B N F . B T T B D I V T F U U T T V S W F Z T I P X F E U I B U Q F S D F O U P G B M M J N B H J O H U F T U T X F S F P S E F S F E G P S E F G F O T J W F Q V S Q P T F T \r B O E Q F S D F O U B O E Q F S D F O U \r S F T Q F D U J W F M Z \r P G U I P T F T V S W F Z F E B E N J U U F E S F E V D J O H U I F O V N C F S P G I J H I S J T L Q B U J F O U T U I F Z T B X B O E M J N J U J O H U I F O V N C F S P G I J H I S J T L Q S P D F E V S F T P S T F S W J D F T U I F Z Q F S G P S N F E % F G F O T J W F N F E J D J O F J T O P U P S J P V T M Z I B S E U P R V B O U J G Z \r C V U T P N F F T U J N B U F T Q M B D F U I F B O O V B M D P T U B U $100 billion to $200 billion P S N P S F ³24 ² 5 I F Z G P V O E U I B U M J B C J M J U Z S F G P S N T D P V M E S F E V D F E F G F O T J W F N F E J D J O F Q S B D U J D F T \r M F B E J O H U P B Q F S D F O U U P Q F S D F O U S F E V D U J P O J O N F E J D B M F Y Q F O E J U V S F T X J U I P V U B O Z F G G F D U P O N P S U B M J U Z P S N F E J D B M D P N Q M J D B U J P O T * G U I F , F T T M F S B O E . D $ M F M M B O F T U J N B U F T X F S F B Q Q M J F E U P U P U B M 6 4 I F B M U I D B S F T Q F O E J O H J O \r U I F E F G F O T J W F N F E J D J O F D P T U T X P V M E U P U B M C F U X F F O $100 billion and $178 billion Q F S Z F B S ³25 ² & T U J N B U F T G S P N U I F T F N P E F M T T V H H F T U U I B U M B X T M J N J U J O H N B M Q S B D U J D F Q B Z N F O U T M P X F S T U B U F I F B M U I D B S F F Y Q F O E J U V S F T C Z C F U X F F O 3 percent and 4 percent ³26 ² 0 V S S F D F O U T U V E Z P G U I F M B S H F T U $ B M J G P S O J B I P T Q J U B M T U I P T F X J U I T V G ¾ D J F O U O V N C F S T P G Q B U J F O U T U P B M M P X B D D V S B U F N F B T V S F N F O U P G S F T P V S D F V T F \n T I P X F E U I B U . F E J D B S F T Q F O E J O H Q F S Q B U J F O U J O U I F M B T U U X P Z F B S T P G M J G F S B O H F E G S P N \r U P \r 5 I F Q P U F O U J B M T B W J O H T B S F F O P S N P V T ' P S F Y B N Q M F \r P W F S U I F ¾ W F Z F B S Q F S J P E P G U I J T T U V E Z \n \r . F E J D B S F D P V M E I B W F T B W F E $1.7 billion in the Los Angeles market B M P O F J G D B S F Q B U U F S O T J O - P T " O H F M F T N J S S P S F E U I P T F P G 4 B D S B N F O U P ³27 16 Where can $700 billion in waste be cut annually? PREVENTABLE CONDITIONS AND AVOIDABLE CAREReasonable Range For Annual Waste: $25!$50 Billion 5 J N F M Z B D D F T T U P R V B M J U Z P V U Q B U J F O U D B S F D B O Q S F W F O U U I F O F F E G P S I P T Q J U B M J [ B U J P O P S P U I F S B D V U F D B S F F H \r F N F S H F O D Z S P P N D B S F \n * O B O F G G P S U U P S F E V D F X B T U F J O U I J T B S F B \r U I F " H F O D Z G P S ) F B M U I D B S F 3 F T F B S D I B O E 2 V B M J U Z " ) 3 2 \n I B T E F ¾ O F E B T F U P G N F B T V S F T P G Q S F W F O U B C M F V U J M J [ B U J P O C B T F E P O J E F O U J G Z J O H ² " N C V M B U P S Z $ B S F 4 F O T J U J W F $ P O E J U J P O T ³ " $ 4 $ \n 28 5 I J T H V J E F M J O F J T B H P P E Q M B D F U P C F H J O B O F Y Q M P S B U J P O P G
16 Q S F W F O U B C M F D P O E J U J
Q S F W F O U B C M F D P O E J U J P O T B O E B W P J E B C M F D B S F B J N F E B U S F E V D J O H X B T U F How widespread is waste from preventable conditions and avoidable care? The evidence reveals some interesting statistics: ² ' P S F Y B N Q M F \r S F T F B S D I T I P X T U I B U I P T Q J U B M B E N J T T J P O T Q F S F W F S Z \r Q F P Q M F B H F E U P J O U I F 6 O J U F E 4 U B U F T B S F G P S V O D P O U S P M M F E E J B C F U F T " H P B M P G ) F B M U I Z 1 F P Q M F \r U I F % F Q B S U N F O U P G ) F B M U I B O E ) V N B O 4 F S W J D F T µ ) ) 4 \n S P B E N B Q G P S J N Q S P W J O H " N F S J D B O T µ I F B M U I \r J T U P S F E V D F I P T Q J U B M J [ B U J P O S B U F T G P S V O D P O U S P M M F E E J B C F U F T G P S Q F S T P O T J O U I J T B H F C S B D L F U U P Q F S \r Q F P Q M F \r X I J D I I F B M U I F Y Q F S U T B H S F F D B O C F B D D P N Q M J T I F E C Z J N Q S P W J O H U I F R V B M J U Z P G P V U Q B U J F O U E J B C F U F T D B S F B O E B D D F T T U P T V D I T F S W J D F T ³35 ² 5 I F O V N C F S P G I P T Q J U B M J [ B U J P O T G P S Q P U F O U J B M M Z B W P J E B C M F D P O E J U J P O T J O D S F B T F E G S P N N J M M J P O J O U P N J M M J P O J O 5 I J T X B T Q F S D F O U P G B M M I P T Q J U B M J [ B U J P O T J O F Y D M V E J O H X P N F O X J U I E F M J W F S J F T \r O F X C P S O J O G B O U T \r B O E Q T Z D I J B U S J D B E N J T T J P O T \n \r C V U Q F S D F O U J O ³29 ² 5 P U B M O B U J P O B M D P T U T B T T P D J B U F E X J U I Q P U F O U J B M M Z B W P J E B C M F I P T Q J U B M J [ B U J P O T \r W B M V F P G 29.6 billion ³30 ² * O \r I P T Q J U B M D P T U T G P S Q P U F O U J B M Q S F W F O U B C M F D P O E J U J P O T U P U B M F E O F B S M Z $30.8 billion ± P O F J O F W F S Z E P M M B S T P G U P U B M I P T Q J U B M F Y Q F O E J U V S F 0 O F J O ¾ W F Q F S D F O U \n . F E J D B S F B E N J T T J P O T X B T G P S B Q P U F O U J B M M Z Q S F W F O U B C M F D P O E J U J P O ³31 ² " O B W F S B H F I P T Q J U B M T U B Z D P T U T \r Q F S B E N J T T J P O \r B O E F W F O B ¾ W F Q F S D F O U E F D S F B T F J O I P T Q J U B M J [ B U J P O T G P S " $ 4 $ T X P V M E T B W F N P S F U I B O $1.3 billion J O B O O V B M J O Q B U J F O U D P T U T ³32 ² ' P S F Y B N Q M F \r J G U I F O V N C F S P G Q S F W F O U B C M F I P T Q J U B M J [ B U J P O T G P S U I F D P O E J U J P O T T U V E J F E X F S F U P E F D S F B T F C Z K V T U Q F S D F O U \r U I F T B W J O H T J O I P T Q J U B M D I B S H F T X P V M E C F N P S F U I B O $280 million ³33 ² © J O B Q Q S P Q S J B U F N B O B H F N F O U P G I Z Q F S U F O T J P O D P O U S J C V U F T T V C T U B O U J B M M Z U P I F B M U I D B S F S F T P V S D F V U J M J [ B U J P O B O E B T T P D J B U F E D P T U T J O U I F 6 O J U F E 4 U B U F T 5 I F P W F S B M M Q S F W B M F O D F P G I Z Q F S U F O T J P O X B T F T U J N B U F E B U Q F S D F O U \r X J U I Q F S D F O U P G J E F O U J ¾ F E Q B U J F O U T U S F B U F E J O B Q Q S P Q S J B U F M Z 5 I F Q F S Q F S T P O D P T U G P S J O B Q Q S P Q S J B U F U S F B U N F O U X B T \r B O E U I F U P U B M O
17 B U J P O B M D P T U X B T B Q Q
B U J P O B M D P T U X B T B Q Q S P Y J N B U F M Z $13 billion ³57 Where can $700 billion in waste be cut annually? 17 ² 3 F H V M B S V T F P G J O I B M F E T U F S P J E T X P V M E S F E V D F I P T Q J U B M J [ B U J P O T C Z Q F S D F O U B O E D P V M E B W P J E E J S F D U N F E J D B M D P T U T U P U B M J O H $2.5 billion F B D I Z F B S ³ ² " O F T U J N B U F E $9.5 billion J O D I B S H F T J O D V S S F E J O S V S B M I P T Q J U B M T O B U J P O X J E F J O X B T G P V O E U P C F B T T P D J B U F E X J U I I P T Q J U B M J [ B U J P O T E V F U P " $ 4 $ T 0 V S ¾ O E J O H T T V H H F T U U I B U U I F T N B M M F S B S V S B M I P T Q J U B M \r U I F H S F B U F S U I F Q P S U J P O P G J U T ¾ O B O D J B M S F T P V S D F T V T F E U P U S F B U Q B U J F O U T X J U I " $ 4 $ ³34 ² 5 I F Q S P Q P S U J P O P G " ) $ T B T T F T T F E B T avoidable varies from 13 percent to 46 percent E F Q F O E J O H P O U I F T P V S D F " E P M F T D F O U T \r D I J M E S F O X J U I B T U I N B \r D I J M E S F O G S P N X P S L J O H Q P P S G B N J M J F T \r B O E V O J O T V S F E D I J M E S F O B S F B U H S F B U F T U S J T L G P S B W P J E B C M F I P T Q J U B M J [ B U J P O T . B O Z Q F E J B U S J D I P T Q J U B M J [ B U J P O T N J H I U C F B W P J E F E J G Q B S F O U T B O E D I J M E S F O X F S F C F U U F S F E V D B U F E B C P V U U I F D I J M E µ T D P O E J U J P O \r N F E J D B U J P O T \r U I F O F F E G P S G P M M P X V Q D B S F \r B O E U I F J N Q P S U B O D F P G B W P J E J O H L O P X O E J T F B T F U S J H H F S T ³36 ² 5 I F F D P O P N J D C V S E F O B T T P D J B U F E X J U I B W P J E B C M F I P T Q J U B M J [ B U J P O T E V F U P E F I Z E S B U J P O J O F M E F S M Z Q B U J F O U T X B T T V C T U B O U J B M * O \r U I F Q P U F O U J B M O B U J P O B M T B W J O H G S P N B W P J E B C M F I P T Q J U B M J [ B U J P O T J O U I F T F Q B U J F O U T D P V M E I B W F C F F O B T N V D I B T $1.14 billion ³37 ² © X F G P V O E U I B U J O ¿ B U J P O B E K V T U F E T Q F O E J O H P O O V S T J O H I P N F I P T Q J U B M J [ B U J P O T J O D S F B T F E Q F S D F O U G S P N U I S P V H I # Z \r B H H S F H B U F T Q F O E J O H U P U B M F E S P V H I M Z $972 million \r P G X I J D I Q F S D F O U X B T B U U S J C V U B C M F U P B N C V M B U P S Z D B S F T F O T J U J W F D P O E J U J P O T ³58 ² & G G P S U T U P S F E V D F U I F O V N C F S P G . F E J D B S F C F O F ¾ D J B S J F T X I P F Y Q F S J F O D F B Q S F W F O U B C M F I P T Q J U B M J [ B U J P O N B Z C F D P T U F G G F D U J W F B T U I F T F C F O F ¾ D J B S J F T N B Z B D D P V O U G P S V Q U P 17.4 percent of Medicare!s reimbursement G P S J O Q B U J F O U \r P V U Q B U J F O U \r B O E Q I Z T J D J B O T F S W J D F T J O P V S E B U B T F U ³38 ² 5 I F U P U B M F T U J N B U F E D P T U P G E J B C F U F T J O J T C J M M J P O \r J O D M V E J O H C J M M J P O J O F Y D F T T N F E J D B M F Y Q F O E J U V S F T B O E C J M M J P O J O S F E V D F E O B U J P O B M Q S P E V D U J W J U Z . F E J D B M D P T U T B U U S J C V U F E U P E J B C F U F T J O D M V E F C J M M J P O G P S D B S F U P E J S F D U M Z U S F B U E J B C F U F T \r C J M M J P O U P U S F B U U I F Q
18 P S U J P O P G E J B C F U F T S
P S U J P O P G E J B C F U F T S F M B U F E D I S P O J D D P N Q M J D B U J P O T U I B U B S F B U U S J C V U F E U P E J B C F U F T \r B O E $31 billon J O F Y D F T T H F O F S B M N F E J D B M D P T U T ³39 ² © U P U B M F T U J N B U F E O B U J P O X J E F D P T U T G P S T I P S U U F S N D P N Q M J D B U J P O T B O E V O D P O U S P M M F E E J B C F U F T I P T Q J U B M J [ B U J P O T U P U B M F E P W F S $1.3 billion ³40 Timely access to quality outpatient care can prevent the need for hospitalization or other acute care. 18 Where can $700 billion in waste be cut annually? FRAUD AND ABUSE Reasonable Range for Annual Waste: $125!$175 Billion ² 5 I F ' F E F S B M # V S F B V P G * O W F T U J H B U J P O ' # * \n F T U J N B U F T U I B U G S B V E V M F O U C J M M J O H T U P Q V C M J D B O E Q S J W B U F I F B M U I D B S F Q S P H S B N T B S F Q F S D F O U P G U P U B M I F B M U I T Q F O E J O H \r P S ° C J M M J P O J O ¾ T D B M Z F B S ³41 ² ' S B V E B O E B C V T F ³ P D D V Q J F T U I F F Y U S F N F F O E P G U I F D P O U J O V V N P G B Q Q S P Q S J B U F O F T T P G V T F B O E Q P U F O U J B M X B T U F 8 I J M F B S H V N F O U T D B O C F N B E F B C P V U U I F B Q Q S P Q S J B U F O F T T P G T P N F P G U I F D B S F E F T D S J C F E J O U I F Q S F W J P V T T F D U J P O \r B O E \r U I F S F G P S F \r J U T D M B T T J ¾ D B U J P O B T X B T U F \r O P S F B T P O B C M F B S H V N F O U D B O C F N B E F G P S U I F D P O U S J C V U J P O P G G S B V E B O E B C V T F U P R V B M J U Z P G D B S F P S P V U D P N F T 5 I F Z B S F D B T F T P G J O U F O U J P O B M N J T S F Q S F T F O U B U J P O S F T V M U J O H J O F Y D F T T Q B Z N F O U \r J O D M V E J O H C J M M J O H G P S T F S W J D F T O F W F S S F O E F S F E B O E U I F L O P X J O H Q S P W J T J P O P G V O O F D F T T B S Z D B S F . P T U G S B V E V M F O U B O E B C V T J W F Q S B D U J D F T T J N Q M Z B E E D P T U X J U I O P W B M V F \r C V U P U I F S T B D U V B M M Z F Y Q P T F Q B U J F O U T U P U I F S J T L B T T P D J B U F E X J U I V O O F D F T T B S Z Q S P D F E V S F T 1 S B D U J D F T M F B E J O H U P X B T U F J O D M V E F 5 I F J O U F O U J P O B M Q S P W J T J P O P G V O O F D F T T B S Z P S J O B Q Q S P Q S J B U F T F S W J D F T # J M M J O H G P S T F S W J D F T O F W F S Q S P W J E F E \r P G U F O X J U I Q B U J F O U T µ Q B S U J D J Q B U J P O J O U I F G S B V E \r P G U F O G P S E F D F B T F E Q B U J F O U T . J T S F Q S F T F O U B U J P O P G U I F D P T U P G D B S F C Z J O T V S F S T U P H S P V Q Q M B O T Q P O T P S T , J D L C B D L T G P S S F G F S S B M T G P S V O O F D F T T B S Z T F S W J D F T . J T C S B O E J O H P G B E S V H C Z B Q I B S N B D F V U J D B M D P N Q B O Z " C V T F P G U I F I F B M U I D B S F T Z T U F N C Z Q B U J F O U T U P S F D F J W F I B S N G V M T F S W J D F T \r T V D I B T . F E J D B J E S F D J Q J F O U T X J U I E S V H B E E J D U J P O T F O S P M M J O H J O N V M U J Q M F T U B U F T Most fraudulent and abusive practices simply add cost with no value, but others actually expose patients to the risk associated with unnecessary procedures. Where can $700 billion in waste be cut annually? 19 Evidence of fraud and abuse reveals an area where waste could de!nitely be reduced, saving money and ultimately providing better care and se
19 rvice to patients: ² © J O
rvice to patients: ² © J O \r X I F O U I F 6 4 T Q F O U O F B S M Z U S J M M J P O P O I F B M U I D B S F B O E C P U I Q V C M J D B O E Q S J W B U F J O T V S F S T Q S P D F T T F E N P S F U I B O C J M M J P O I F B M U I J O T V S B O D F D M B J N T \r G S B V E X B T F T U J N B U F E U P S F B D I B T N V D I B T Q F S D F O U P G B O O V B M I F B M U I D B S F T Q F O E J O H 8 J U I U I J T S B U F \r U I F M P T T F T J O X P V M E I B W F C F F O N P S F U I B O $220 billion ± P S F O P V H I U P D P W F S U I F V O J O T V S F E ± J G F T U J N B U F T G S P N H P W F S O N F O U B O E M B X F O G P S D F N F O U B S F V T F E ³42 ² 5 I F / B U J P O B M ) F B M U I D B S F " O U J ' S B V E " T T P D J B U J P O \r B O P S H B O J [ B U J P O P G B C P V U Q S J W B U F J O T V S F S T B O E Q V C M J D B H F O D J F T \r F T U J N B U F T U I B U T P N F $60 billion B C P V U Q F S D F O U P G U P U B M B O O V B M I F B M U I D B S F T Q F O E J O H \n J T M P T U U P G S B V E F W F S Z Z F B S \r C V U U I B U ¾ H V S F J T D P O T J E F S F E D P O T F S W B U J W F * O \r H P W F S O N F O U X J E F ² J N Q S P Q F S Q B Z N F O U T ³ D P T U U I F 6 4 5 S F B T V S Z $72 billion \r P S B C P V U Q F S D F O U \r P G U P U B M P V U M B Z T G P S U I F S F M B U F E Q S P H S B N T ³43 20 Where can $700 billion in waste be cut annually? SHOULD THESE BE CONSIDERED WASTE? " M U I P V H I S F Q S F T F O U J O H T J H O J ¾ D B O U D P T U T \r U X P D B U F H P S J F T P G Q P U F O U J B M F Y D F T T I F B M U I D B S F F Y Q F O T F I B W F C F F O U S F B U F E E J G G F S F O U M Z J O N P T U E J T D V T T J P O T B C P V U I F B M U I D B S F T Z T U F N X B T U F # P U I B S F P G U F O D P O T J E F S F E B T P Q Q P S U V O J U J F T U P S F E V D F I F B M U I D B S F T Q F O E J O H X J U I P V U I B W J O H B O F H B U J W F J N Q B D U P O P V S Q P Q V M B U J P O µ T I F B M U I / F J U I F S \r I P X F W F S \r S F Q S F T F O U T B O P Q Q P S U V O J U Z J N N F E J B U F M Z U P S F E V D F D P T U T C Z F J U I F S B Q Q M Z J O H S F T P V S D F T N P S F F G ¾ D J F O U M Z P S E J T D P O U J O V J O H V O O F D F T T B S Z T F S W J D F T B O E Q B Z N F O U T # P U I I B W F T J H O J ¾ D B O U D V M U V S B M D I B S B D U F S J T U J D T P S Q S F D F E F O U T ' J S T U \r U I F M J U F S B U V S F S F Q P S U T F Y U F O T J W F F W J E F O D F U I B U T F W F S B M C F I B W J P S T \r D P N N P O J O U I F Q P Q V M B U J P O \r B E E T J H O J ¾ D B O U D P T U U P I F B M U I D B S F 5 I F T F J O D M V E F B M D P I P M J T N \r T V C T U B O D F B C V T F \r V T F P G U P C B D D P \r B O E M B D L P G F Y F S D J T F B O E P W F S F B U J O H \r X J U I S F T V M U J O H P C F T J U Z 4 F D P O E \r G P S N B O Z Z F B S T \r F D P O P N J T U T I B W F T V H H F T U F E U I B U U I F N P T U T J H O J ¾ D B O U E J G G F S F O D F J O F Y Q F O E J U V S F T P O I F B M U I D B S F C F U X F F O U I F 6 4 B O E P U I F S E F W F M P Q F E D P V O U S J F T J T U I F S F M B U J W F M Z I J H I Q S J D F P G T F S W J D F T J O U I F 6 4 4 P N F F W F O B S H V F U I B U V T F P G T F S W J D F T J T B D U V B M M Z M P X F S J O U I F 6 4 B O E Q S J D F B M P O F J T U I F D B V T F INCREASED DISEASE DUE T
20 O MODIFIABLE BEHAVIORS * U T F F N T
O MODIFIABLE BEHAVIORS * U T F F N T S F B T P O B C M F U P D P O T J E F S U I F D P T U T P G U S F B U J O H B Q S F W F O U B C M F D P O E J U J P O B T X B T U F & Y Q F S U T B H S F F U I B U N B O Z D P O E J U J P O T D P V M E C F B W P J E F E C Z F O H B H J O H J O B I F B M U I J F S M J G F T U Z M F ) P X F W F S \r N P T U F T U J N B U F T P G I F B M U I D B S F T Z T U F N X B T U F E P O P U J O D M V E F U I J T D B U F H P S Z \r T J O D F U I F J N Q B D U P G U I F T F C F I B W J P S T J T D P O T J E F S F E P V U T J E F P G U I F E J S F D U D P O U S P M B O E S F T Q P O T J C J M J U Z P G U I F I F B M U I D B S F T Z T U F N 5 I F M J U F S B U V S F E P F T E F N P O T U S B U F U I F I J H I F S M J G F U J N F D P T U T P G I F B M U I D B S F G P S Q F S T P O T X I P N B J O U B J O V O I F B M U I Z M J G F T U Z M F T . B O Z I F B M U I Q M B O T B O E Q M B O T Q P O T P S T I B W F S F D P H O J [ F E U I F P Q Q P S U V O J U Z U P S F E V D F U I F J S D P T U T \r C P U I J O N F E J D B M D B S F B O E J O F N Q M P Z N F O U S F M B U F E D P T U T T V D I B T B C T F O U F F J T N B O E E J T B C J M J U Z \r C Z F O D P V S B H J O H B O E T V Q Q P S U J O H N F N C F S M J G F T U Z M F D I B O H F T * U J T E J G ¾ D V M U U P U S F B U T V D I D P T U T T F Q B S B U F M Z G S P N F Y Q F O T F T E F T D S J C F E J O U I F P U I F S D B U F H P S J F T \r T J O D F T J N Q M Z S F E V D J O H U I F Q S F W B M F O D F P G U I F T F D P O E J U J P O T X P V M E F M J N J O B U F N V D I P G U I B U X B T U F ' P S F Y B N Q M F \r U I F F Y J T U J O H X B T U F J O U S F B U J O H D P S P O B S Z B S U F S Z E J T F B T F F H \r J O F G ¾ D J F O U Q S P W J E F S T \r V O O F D F T T B S Z Q S P D F E V S F T \r B W P J E B C M F D P N Q M J D B U J P O T \n X P V M E C F S F E V D F E T J N Q M Z C Z S F E V D J O H U I F J O D J E F O D F P G U I F D P O E J U J P O U I S P V H I C F U U F S M J G F T U Z M F * G U I J T Q B Q F S X F S F J E F O U J G Z J O H B O E R V B O U J G Z J O H P Q Q P S U V O J U J F T U P S F E V D F I F B M U I D B S F T Z T U F N D P T U T S B U I F S U I B O U I F M F W F M P G T Z T U F N X B T U F J O U S F B U J O H F Y J T U J O H I F B M U I D P O E J U J P O T \r U I J T D P T U X P V M E C F J O D M V E F E J O U I F F T U J N B U F ) P X F W F S \r X F X J M M T B U J T G Z P V S T F M W F T I F S F C Z T J N Q M Z J E F O U J G Z J O H U I J T B T B T J H O J ¾ D B O U P Q Q P S U V O J U Z G P S S F E V D J O H D P T U T C Z S F E V D J O H U I F S F B M O F F E G P S I F B M U I D B S F 5 I P V H I U I J T B S F B P G X B T U F J T O P U J O D M V E F E B N P O H P V S T J Y D B U F H P S J F T \r J U Q S F T F O U T B O P Q Q P S U V O J U Z G P S B O O V B M avoidable costs of between $150-$200 billion. Where can $700 billion in waste be cut annually? 21 Increased disease due to modi!able behaviors take a toll on health in the United States. The evidence con!rms the high cost of poor choices: 0 C F T J U Z B O E 1 I Z T J D B M * O B D U J W J U Z ² 8 F F T U J N B U F U I B U Q F S N B O F O U L D B M S F E V D U J P O T J O E B J M Z J O U B L F X P V M E F M J N J O B U F B Q Q S P Y J N B U F M Z N J M M J P O D B T F T P G P W F S X F J H I U P C F T J U Z B O E T B W F C J M M J P O B O O V B M M Z . P E F T U U P B H H S F T T J W
21 F D I B O H F T J O E J F U D B
F D I B O H F T J O E J F U D B O J N Q S P W F I F B M U I B O E S F E V D F B O O V B M O B U J P O B M N F E J D B M F Y Q F O E J U V S F T C Z $60 billion to $120 billion ³45 ² 8 F G P V O E U I B U U I F J O D S F B T F E Q S F W B M F O D F P G P C F T J U Z J T S F T Q P O T J C M F G P S B M N P T U C J M M J P O P G J O D S F B T F E N F E J D B M T Q F O E J O H U I S P V H I \r J O D M V E J O H $7 billion J O . F E J D B S F Q S F T D S J Q U J P O E S V H D P T U T 8 F F T U J N B U F U I B U U I F N F E J D B M D P T U T P G P C F T J U Z D P V M E I B W F S J T F O U P $147 billion per year by 2008 ³46 ² 1 I Z T J D B M J O B D U J W J U Z \r P W F S X F J H I U \r B O E P C F T J U Z X F S F B T T P D J B U F E X J U I Q F S D F O U Q F S D F O U D P O ¾ E F O D F J O U F S W B M á $ * \r Q F S D F O U ° Q F S D F O U \n P G I F B M U I Q M B O I F B M U I D B S F D I B S H F T B O E 27 percent ° Q F S D F O U $ * \r Q F S D F O U ° Q F S D F O U \n P G O B U J P O B M I F B M U I D B S F D I B S H F T ³47 ² 5 I F E J S F D U D P T U T P G M B D L P G Q I Z T J D B M B D U J W J U Z \r E F ¾ O F E D P O T F S W B U J W F M Z B T B C T F O D F P G M F J T V S F U J N F Q I Z T J D B M B D U J W J U Z \r B S F B Q Q S P Y J N B U F M Z C J M M J P O E P M M B S T P S Q F S D F O U P G U I F 6 4 I F B M U I D B S F F Y Q F O E J U V S F T % J S F D U D P T U T G P S P C F T J U Z E F ¾ O F E B T C P E Z N B T T J O E F Y H S F B U F S U I B O \r J O E P M M B S T \r U P U B M 70 billion dollars 5 I F T F D P T U T B S F J O E F Q F O E F O U P G U I P T F S F T V M U J O H G S P N M B D L P G B D U J W J U Z ³48 ² 5 I F U P U B M N F E J D B M F Y Q F O E J U V S F P G Q F S T P O T X J U I D B S E J P W B T D V M B S E J T F B T F X B T 6 4 C J M M J P O E P M M B S T \r P G X I J D I 6 4 5.4 billion dollars Q F S D F O U \n X B T B T T P D J B U F E X J U I J O B D U J W J U Z ³49 4 N P L J O H ² 4 N P L J O H D P T U T U I F O B U J P O C J M M J P O F B D I Z F B S J O I F B M U I D P T U T B O E M P T U Q S P E V D U J W J U Z & D P O P N J D D P T U T E V S J O H U I F T B N F Q F S J P E X F S F C J M M J P O J O Q S P E V D U J W J U Z M P T T F T G S P N E F B U I T B W F S B H F G P S ° \n B O E $75.5 billion J O F Y D F T T N F E J D B M F Y Q F O E J U V S F T J O \r G P S B U P U B M P G N P S F U I B O C J M M J P O \r B D D P S E J O H U P U I F S F Q P S U 5 I F S F Q P S U F E N F E J D B M B O E Q S P E V D U J W J U Z M P T T F T X F S F M B S H F S U I B O Q S F W J P V T F T U J N B U F T P G C J M M J P O B O E C J M M J P O \r S F T Q F D U J W F M Z ³50 ² 5 I F T N P L J O H B U U S J C V U B C M F G S B D U J P O G P S B M M T U B U F T X B T Q F S D F O U Q F S D F O U D P O ¾ E F O D F J O U F S W B M \r Q F S D F O U ° Q F S D F O U \n . F E J D B J E T N P L J O H B U U S J C V U B C M F F Y Q F O E J U V S F T S B O H F E G S P N N J M M J P O 8 Z P N J O H \n U P C J M M J P O / F X : P S L \n J O B O E U P U B M F E $22 billion O B U J P O X J E F ³51 22 Where can $700 billion in waste be cut annually? " M D P I P M $ P O T V N Q U J P O ² " M D P I P M D P O T V N Q U J P O J O $ B M J G P S O J B M F E U
22 P B O F T U J N B U F E \r
P B O F T U J N B U F E \r E F B U I T B O E \r B M D P I P M S F M B U F E Q S P C M F N T \r T V D I B T D S J N F B O E J O K V S Z \r J O 5 I F F D P O P N J D D P T U P G U I F T F Q S P C M F N T J T F T U J N B U F E B U C F U X F F O C J M M J P O B O E C J M M J P O 0 V S N B J O F T U J N B U F J T C J M M J P O \r P G X I J D I $5.4 billion X B T G P S N F E J D B M B O E N F O U B M I F B M U I T Q F O E J O H \r C J M M J P O J O X P S L M P T T F T \r B O E C J M M J P O J O D S J N J O B M K V T U J D F T Q F O E J O H \r Q S P Q F S U Z E B N B H F \r B O E Q V C M J D Q S P H S B N D P T U T ³52 - B D L P G & Y D F S D J T F ² / F B S M Z Q F S D F O U P G E F Q S F T T J P O B O E B O Y J F U Z B O E Q F S D F O U P G D P M P O D B O D F S \r I F B S U E J T F B T F \r P T U F P Q P S P T J T \r B O E T U S P L F D B T F T X F S F B U U S J C V U B C M F U P Q I Z T J D B M J O B D U J W J U Z ) F B S U E J T F B T F X B T U I F N P T U F Y Q F O T J W F P V U D P N F P G Q I Z T J D B M J O B D U J W J U Z X J U I J O U I F I F B M U I Q M B O Q P Q V M B U J P O N J M M J P O I F B M U I Q M B O N F N C F S T \n \r D P T U J O H 6 4 E P M M B S N J M M J P O J O 5 P U B M I F B M U I Q M B O F Y Q F O E J U V S F T B U U S J C V U B C M F U P Q I Z T J D B M J O B D U J W J U Z X F S F 6 4 E P M M B S 83.6 million \r P S 6 4 E P M M B S Q F S N F N C F S ³53 HIGH PRICE OF MEDICAL SERVICES . B O Z F Y Q F S U T C F M J F W F P O F P G U I F Q S J N B S Z S F B T P O T I F B M U I D B S F D P T U T N P S F J O U I F 6 4 U I B O J O P U I F S D P V O U S J F T J T U I B U N F E J D B M T F S W J D F T B S F T J N Q M Z Q S J D F E I J H I F S J O U I F 6 4 5 I F Z B S H V F U I B U U I F Q V C M J D µ T M B D L P G N B S L F U Q P X F S ± U I F B C J M J U Z U P E S J W F Q S J D F C B T F E P O T V Q Q M Z B O E E F N B O E \r B T X J U I N P T U P U I F S Q S P E V D U T B O E T F S W J D F T ± J T U I F D B V T F P G I J H I Q S J D F T J O Q I Z T J D J B O T F S W J D F T \r I P T Q J U B M T F S W J D F T \r B O E Q S F T D S J Q U J P O E S V H T . B O Z F Y Q F S U T D P N Q B S F U I F J O ¿ B U F E Q S J D F T G P S T Q F D J B M J T U Q F S G P S N F E Q S P D F E V S F T U P U I F V O E F S W B M V F E D P H O J U J W F T F S W J D F T P G Q S J N B S Z D B S F Q I Z T J D J B O T B O E T V H H F T U U I B U O P U P O M Z E P U I F T F Q S J D F T B E E D P T U \r C V U U I F Z F O D P V S B H F P W F S V T F P G U I F T F T F S W J D F T B T E F T D S J C F E J O B Q S F W J P V T X B T U F D B U F H P S Z 4 P N F P G U I F I J H I Q S J D F T N B Z C F E V F U P T Z T U F N J O F G ¾ D J F O D J F T E J T D V T T F E J O B Q S F W J P V T D B U F H P S Z F H \r I P T Q J U B M P Q F S B U J P O B M J O F G ¾ D J F O D J F T \r B E N J O J T U S B U J W F J O F G ¾ D J F O D J F T \n . B O Z F Y Q F S U T G P D V T P O U I F I J H I Q S J D F T P G Q S F T D S J Q U J P O E S V H T J O U I F 6 4 D P N Q B S F E U P P U I F S D P V O U S J F T 4 P N F D P V O U F S U I B U I J H I F S Q S J D F T F O D P V S B H F B O E G V O E J N Q P S U B O U S F T F B S D I B O E E F W F M P Q N F O U P G O F X \r W B M V B C M F E S V H T 0 U I F S T \r
23 I P X F W F S \r D M B J N U I B
I P X F W F S \r D M B J N U I B U N V D I E F W F M P Q N F O U T J N Q M Z S F T V M U T J O O F X ² N F U P P ³ C S B O E O B N F E S V H T U I B U B E E M J U U M F D M J O J D B M B E W B O U B H F P W F S F Y J T U J O H E S V H T \r C V U J O D S F B T F Q I B S N B D F V U J D B M Q S P ¾ U T U I S P V H I B H H S F T T J W F N B S L F U J O H U P Q I Z T J D J B O T B O E U I F Q V C M J D Thomson Reuters study P G U I F F G G F D U T P G D P N Q F U J U J P O P O I P T Q J U B M Q S J D F T \r Q V C M J T I F E C Z U I F ) F B M U I D B S F ' J O B O D J B M . B O B H F N F O U " T T P D J B U J P O \r G P V O E U I B U I P T Q J U B M T F S W J D F T T I P X X J E F S B O H F T J O Q S J D F X J U I J O B T Q F D J ¾ D H F P H S B Q I Z ² * U J T O P U V O V T V B M G P S U I F W B S J B U J P O J O I P T Q J U B M Q S J D F T U P S F B D I Q F S D F O U P S N P S F ' P S F Y B N Q M F \r U I F Q S J D F T P G C S B J O . 3 * T J O " U M B O U B W B S Z Q F S D F O U B S P V O E B N F E J B O P G \r * G H B T P M J O F Q S J D F T T I P X F E B T J N J M B S B N P V O U P G W B S J B U J P O \r Q S J D F T X P V M E S B O H F G S P N U P X I F O U I F N F E J B O J T B U Q F S H B M M P O ³ 54 Where can $700 billion in waste be cut annually? 23 The following evidence indicates that medical services and pharmaceuticals are overpriced in the United States ² 5 I F S B U J P P G U I F B W F S B H F J O D P N F P G 6 4 Q I Z T J D J B O T U P B W F S B H F F N Q M P Z F F D P N Q F O T B U J P O G P S U I F 6 O J U F E 4 U B U F T B T B X I P M F X B T B C P V U ( F S N B O Z µ T X B T U I F O F Y U I J H I F T U \r B U P O M Z $ B O B E B \r " V T U S B M J B \r 4 X J U [ F S M B O E \r ' S B O D F \r 4 X F E F O \r B O E U I F 6 O J U F E , J O H E P N \r ³55 ² 5 I F E B U B T I P X U I B U U I F 6 O J U F E 4 U B U F T T Q F O E T N P S F P O I F B M U I D B S F U I B O B O Z P U I F S D P V O U S Z ) P X F W F S \r P O N P T U N F B T V S F T P G I F B M U I T F S W J D F T V T F \r U I F 6 O J U F E 4 U B U F T J T C F M P X U I F 0 & $ % N F E J B O 5 I F T F G B D U T T V H H F T U U I B U U I F E J G G F S F O D F J O T Q F O E J O H J T D B V T F E N P T U M Z C Z I J H I F S Q S J D F T G P S I F B M U I D B S F H P P E T B O E T F S W J D F T J O U I F 6 O J U F E 4 U B U F T ³56 ² 5 I F S F T F B S D I F S T F T U J N B U F E U I B U " N F S J D B O T Q B J E Q F S D F O U N P S F Q F S D B Q J U B U I B O ( F S N B O T E J E C V U S F D F J W F E Q F S D F O U G F X F S S F B M I F B M U I D B S F S F T P V S D F T " T J N J M B S D P N Q B S J T P O S F W F B M F E U I B U U I F 6 4 T Z T U F N V T F E B C P V U Q F S D F O U N P S F J O Q V U T Q F S D B Q J U B U I B O X B T V T F E J O U I F # S J U J T I T Z T U F N B O E T Q F O U B C P V U Q F S D F O U N P S F Q F S D B Q J U B P O I J H I F S Q S J D F T ³56 ² © ' V D I T B O E ) B I O G P V O E U I B U ² 6 4 G F F T G P S Q S P D F E V S F T B S F N P S F U I B O U I S F F U J N F T B T I J H I B T $ B O B E J B O G F F T&#x B O;&#x E 0; U I F E J G G F S F O D F J O G F F T G P S F W B M V B U J P O B O E N B O B H F N F O U T F S W J D F T J T B C P V U Q F S D F O U ³56 ² # Z
24 U I F T F N P T U D P N Q S F I F
U I F T F N P T U D P N Q S F I F O T J W F J O E F Y F T \r + B Q B O µ T E S V H Q S J D F T B S F I J H I F T U \r G P M M P X F E C Z 6 4 Q S J D F T $ B O B E B µ T Q S J D F T B S F M P X F T U Q F S D F O U M P X F S U I B O 6 4 Q S J D F T O F U P G E J T D P V O U T \r B O E Q F S D F O U M P X F S J H O P S J O H E J T D P V O U T 1 S J D F T J O ( F S N B O Z \r * U B M Z \r B O E U I F 6 O J U F E , J O H E P N B S F M F T T U I B O Q F S D F O U M P X F S U I B O 6 4 Q S J D F T \r O F U P G E J T D P V O U T \r X I F S F B T Q S J D F T J O ' S B O D F B S F Q F S D F O U M P X F S ³59 6 T J O H U I F Thomson Reuters MarketScan E B U B C B T F \r B T J N Q M F D P N Q B S J T P O B D S P T T H F P H S B Q I J D S F H J P O T P G U I F E J G G F S F O D F J O B W F S B H F Q S J D F G P S U I F T B N F T F S W J D F C F U X F F O I P T Q J U B M P V U Q B U J F O U E F Q B S U N F O U T B O E G S F F T U B O E J O H G B D J M J U J F T T V H H F T U T U I B U U I F I P T Q J U B M Q S J D F B E W B O U B H F J O D S F B T F T X J U I B S J T F J O U I F N B S L F U E P N J O B O D F P G I P T Q J U B M T 5 I J T ¾ O E J O H N B Z C F B O F Y B N Q M F P G U I F M B D L P G F G G F D U J W F Q S J D F D P N Q F U J U J P O S F T V M U J O H G S P N T U S V D U V S B M D I B S B D U F S J T U J D T P G I F B M U I D B S F N B S L F U T 24 Where can $700 billion in waste be cut annually? CONCLUSIONS 0 V S P C K F D U J W F X B T U P D P N C J O F 5 I P N T P O 3 F V U F S T S F T F B S D I X J U I F W J E F O D F G S P N Q V C M J T I F E S F T F B S D I B O E F Y Q F S U P Q J O J P O U P T V Q Q P S U B N F B O J O H G V M B O E D S F E J C M F F T U J N B U F G P S U I F B N P V O U P G X B T U F J O U I F I F B M U I D B S F T Z T U F N 8 F G F F M U I B U B O F T U J N B U F P G $700 billion J T X F M M T V Q Q P S U F E C Z U I F B W B J M B C M F G B D U T B O E S F T F B S D I 5 I F ¾ S T U T U F Q X B T U P C S F B L E P X O U P U B M X B T U F J O U P J O E F Q F O E F O U D P N Q P O F O U D B U F H P S J F T 5 I F T F D B U F H P S J F T D B O C F D M F B S M Z E F T D S J C F E B O E E J G G F S F O U J B U F E \r B O E S F T F B S D I B O E P U I F S F W J E F O D F Q S P W J E F B S F B T P O B C M F S B O H F P G S F M B U F E X B T U F 5 I F M F W F M P S Q S F D J T J P O O F F E T P O M Z C F T V G ¾ D J F O U U P T V Q Q P S U U I F Q V S Q P T F P G U F T U J O H U I F S F B T P O B C M F O F T T P G U I F U P U B M F T U J N B U F E ¾ H V S F 5 I F S F G P S F \r S F B T P O B C M F S B O H F T D B O C F S F M B U J W F M Z M B S H F 8 F I B W F B T T V N F E U I B U U I F D B U F H P S J F T B S F J O E F Q F O E F O U B O E I B W F \r U I F S F G P S F \r T J N Q M Z B E E F E U I F D P N Q P O F O U T U P D B M D V M B U F U I F S F B T P O B C M F S B O H F G P S U P U B M X B T U F 5 I J T B T T V N Q U J P O J T B Q Q S P Q S J B U F U P U I F M F W F M P G Q S F D J T J P O S F R V J S F E C Z U I F P C K F D U J W F 5 I F S F T V M U J O H S F B T P O B C M F S B O H F G P S U P U B M I F B M U I D B S F T Z T U F N X B T U F J T $600-$850 billion annually 5 I F S F G P S F \r X F D P O D M V E F U I B U E F T J H O B U J O H B O F T U J N B U F E C J M M J P O P S P O F U I J S E P G B O O V B M I F B M U I D B S F F Y Q F O E J U V S F T B T X B
25 T U F J T S F B T P O B C M F B O
T U F J T S F B T P O B C M F B O E N B Z C F F W F O D P O T F S W B U J W F Component Ranges The six component ranges (in billions of dollars) included in the total are: " E N J O J T U S B U J W F 4 Z T U F N * O F G ¾ D J F O D J F T 1 S P W J E F S * O F G ¾ D J F O D Z B O E & S S P S T - B D L P G $ B S F $ P P S E J O B U J P O 6 O X B S S B O U F E 6 T F 1 S F W F O U B C M F $ P O E J U J P O T B O E " W P J E B C M F $ B S F ' S B V E B O E " C V T F Where can $700 billion in waste be cut annually? 25 8 F S F D P H O J [ F U I B U U I F ¾ H V S F P G C J M M J P O I B T P G U F O C F F O R V P U F E X J U I P V U T Q F D J ¾ D S F G F S F O D F U P U I F U Z Q F T P G X B T U F J O D M V E F E ' P S F Y B N Q M F \r T P N F I B W F Q S P C B C M Z O P U J O U F O E F E U P J O D M V E F X B T U F G S P N B E N J O J T U S B U J W F T Z T U F N J O F G ¾ D J F O D J F T \r B O E P U I F S T I B W F O P U J O U F O E F E U P J O D M V E F G S B V E B O E B C V T F 4 P N F I B W F P O M Z J O U F O E F E X B T U F U P J O D M V E F V O X B S S B O U F E V T F \r B W P J E B C M F D B S F B O E N F E J D B M F S S P S T J O U I F J S F T U J N B U F T P G X B T U F 0 V S D P O T J E F S B U J P O P G U I F F W J E F O D F T V H H F T U T U I B U \r S F H B S E M F T T P G U I F D P N Q P O F O U T J O D M V E F E J O B E F ¾ O J U J P O P G X B T U F \r U I F U P U B M D P T U P G X B T U F J T J O E F F E B W F S Z M B S H F ¾ H V S F * U J T D F S U B J O M Z M B S H F F O P V H I U P N F S J U B T J H O J ¾ D B O U J O W F T U N F O U J O B O P O H P J O H F G G P S U U P T F B S D I G P S T Q F D J ¾ D X B T U F \r U P E F T J H O B O E J N Q M F N F O U Q S P H S B N T U P S F E V D F X B T U F \r B O E U P F W B M V B U F B O E S F Q P S U P O U I F T V D D F T T P G U I F T F Q S P H S B N T " U \r V O X B S S B O U F E V T F S F Q S F T F O U T U I F M B S H F T U T I B S F P G X B T U F \r C V U P Q Q P S U V O J U J F T F Y J T U U P S F E V D F X B T U F J O F B D I D B U F H P S Z * U J T F W F O Q P T T J C M F U I B U T P N F T U S B U F H J F T U P S F E V D F X B T U F D P V M E T V D D F F E J O S F E V D U J P O T J O N P S F U I B O P O F D B U F H P S Z * U J T B M T P J N Q P S U B O U U P O P U F U I B U \r B M U I P V H I O P U J O D M V E F E J O P V S F T U J N B U F P G B U P U B M S B O H F \r U I F X B T U F B T T P D J B U F E X J U I U S F B U J O H B M F W F M P G E J T F B T F Q S F W B M F O D F U I B U D P V M E C F T J H O J ¾ D B O U M Z S F E V D F E U I S P V H I N P E J ¾ F E J O E J W J E V B M C F I B W J P S \r J T T J H O J ¾ D B O U " M U I P V H I U I F S F T Q P O T J C J M J U Z G P S Q V S T V J O H B I F B M U I J F S M J G F T U Z M F J T V M U J N B U F M Z B Q F S T P O B M P O F \r U I F I F B M U I D B S F T Z T U F N I B T B O P Q Q P S U V O J U Z U P F O D P V S B H F C F U U F S J O E J W J E V B M D I P J D F T Unwarranted Use40%Fraud and Abuse19%Administrative System Inef®ciencies17%Lack of Care Coordination 6%Preventable Conditions and Avoidable Care 6%Provider Inef®ciency and Errors 12% 1 F S D F O U B H F P G ) F B M U I D B S F 8 B T U F C Z $ B U F H P S Z 5 P U B M J O H # J M M J P O 26 Where can $700 billion in waste be cut annually? REFERENCES 4 U B U F P G U I F
26 / B U J P O µ T ) F B M U I \r E B S
/ B U J P O µ T ) F B M U I \r E B S U N F E E B S U N P V U I F E V \r 4 Q S J O H . F E J D B M ( S P V Q . B O B H F N F O U " T T P D J B U J P O \r 1 P T J U J P O Q B Q F S " E N J O J T U S B U J W F 4 J N Q M J ¾ D B U J P O G P S . F E J D B M ( S P V Q 1 S B D U J D F T + V O F , B J T F S ' B N J M Z ' P V O E B U J P O \r 5 S F O E T J O ) F B M U I D B S F $ P T U T B O E 4 Q F O E J O H \r . B S D I 3 8 B H P O F S \r 5 F T U J N P O Z C F G P S F U I F ) P V T F ' J O B O D J B M 4 F S W J D F T $ P N N J U U F F \r % F D F N C F S \r 8 B T U F B O E * O F G ¾ D J F O D Z J O U I F 6 4 ) F B M U I D B S F 4 Z T U F N \r $ M J O J D B M $ B S F " $ P N Q S F I F O T J W F " O B M Z T J T J O 4 V Q Q P S U P G 4 Z T U F N X J E F * N Q S P W F N F O U T / F X & O H M B O E ) F B M U I D B S F * O T U J U V U F \r ' F C S V B S Z 3 F M F W B O U Q S J N B S Z S F G F S F O D F T # V S L F + 1 * O G F D U J P O $ P O U S P M " 1 S P C M F N G P S 1 B U J F O U 4 B G F U Z New England Journal of Medicine 1 F O O T Z M W B O J B ) F B M U I D B S F $ P T U $ P O U B J O N F O U $ P V O D J M ) P T Q J U B M " D R V J S F E * O G F D U J P O T J O 1 F O O T Z M W B O J B + V M Z \n * T T V F ( J M M + . 6 T F P G ) P T Q J U B M & N F S H F O D Z % F Q B S U N F O U T G P S / P O V S H F O U $ B S F " 1 F S T J T U F O U 1 S P C M F N X J U I / P & B T Z 4 P M V U J P O T American Journal of Managed Care ( P O [ B M F T 3 \r . B M P O F % $ \r . B T F M M J + ) \r 4 B O E F . " & Y D F T T J W F " O U J C J P U J D 6 T F G P S " D V U F 3 F T Q J S B U P S Z * O G F D U J P O T J O U I F 6 O J U F E 4 U B U F T Clinical Infectious Diseases % B O [ P O \r 1 . \r ' V S V L B X B \r . ' 1 S J D F T B O E " W B J M B C J M J U Z 0 G 1 I B S N B D F V U J D B M T & W J E F O D F ' S P N / J O F $ P V O U S J F T Health Affairs 0 D U P C F S 8 F C & Y D M V T J W F 8 8 P P M I B O E M F S 4 \r $ B N Q C F M M 5 \r ) J N N F M T U F J O % 6 $ P T U T P G ) F B M U I D B S F " E N J O J T U S B U J P O J O U I F 6 O J U F E 4 U B U F T B O E $ B O B E B New England Journal of Medicine \r " V H V T U \r \r / V N C F S \r 7 P M V N F $ P M M J O T 4 3 \r / V [ V N 3 \r 3 V T U H J 4 % \r . J L B 4 \r 4 D I P F O $ \r % B W J T , ) P X ) F B M U I D B S F 3 F G P S N $ B O - P X F S U I F $ P T U T P G * O T V S B O D F " E N J O J T U S B U J P O 5 I F 1 S J D F P G & Y D F T T * E F O U J G Z J O H 8 B T U F J O ) F B M U I D B S F 4 Q F O E J O H Issue Brief (Commonwealth Fund) \r + V M Z 5 I F 1 S J D F P G & Y D F T T * E F O U J G Z J O H 8 B T U F J O ) F B M U I D B S F 4 Q F O E J O H X X X Q X D D P N I F B M U I J O E V T U S J F T $ B T B M J O P - 1 \r / J D I P M T P O 4 \r ( B O T % / \r ) B N N P O T 5 \r . P S S B % \r , B S S J T P O 5 \r - F W J O T P O 8 8 I B U % P F T * U $ P T U 1 I Z T J D J B O 1 S B D U J D F T 5 P * O U F S B D U 8 J U I ) F B M U I * O T V S B O D F 1 M B O T Health Affairs \r O P \r Where can $700 billion in waste be cut annually? 27 " D D P V O U J O H G P S U I F $ P T U P G 6
27 4 ) F B M U I D B S F " / F X
4 ) F B M U I D B S F " / F X - P P L B U 8 I Z " N F S J D B O T 1 B Z . P S F X X X N D L J O T F Z D P N N H J Q V C M J D B U J P O T 6 4 @ I F B M U I D B S F & Y F D V U J W F @ 4 V N N B S Z B T Q , P F Q L F \r % 3 F T F B S D I # S J F G # F O D I N B S L J O H 0 Q F S B U J P O B M & G ¾ D J F O D Z B O E $ M J O J D B M 1 F S G P S N B O D F 5 I P N T P O 3 F V U F S T $ F O U F S G P S ) F B M U I D B S F * N Q S P W F N F O U 4 F Q U F N C F S 1 S B U ( \r - F G F W S F . \r / P X B L & \r 5 P O O F M J F S + . \r 3 F O B V M U " \r - µ ) F S & \r # P M F T + . * N Q B D U P G $ M J O J D B M ( V J E F M J O F T U P * N Q S P W F " Q Q S P Q S J B U F O F T T P G - B C P S B U P S Z 5 F T U T B O E $ I F T U 3 B E J P H S B Q I T Intensive Care Med \r \n 5 P & S S * T ) V N B O # V J M E J O H B 4 B G F S ) F B M U I 4 Z T U F N * O T U J U V U F P G . F E J D J O F \r / P W F N C F S 1 S F W F O U J O H . F E J D B U J P O & S S P S T \r * O T U J U V U F P G . F E J D J O F Report Brief \r + V M Z ' V " ; \r + J B O H + ; \r 3 F F W F T + ) \r ' J O D I B N + & \r - J V ( ( \r 1 F S S J . \r S E 1 P U F O U J B M M Z J O B Q Q S P Q S J B U F N F E J D B U J P O V T F B O E I F B M U I D B S F F Y Q F O E J U V S F T J O U I F 6 4 D P N N V O J U Z E X F M M J O H F M E F S M Z Med Care \r \n # F O U M F Z 5 ( , \r & G G S P T 3 . \r 1 B M B S , \r , F F M F S & # \r 8 B T U F J O U I F 6 4 ) F B M U I D B S F 4 Z T U F N " $ P O D F Q U V B M ' S B N F X P S L The Milbank Quarterly 7 P M \r / P \r \n - " 5 J N F T 1 S F T T 3 F M F B T F \r / B U J P O B M " D B E F N J F T \r + V M Z \r J O U F S O B M T U S B U F H Z E P D V N F O U T \r / P W F N C F S \r 4 P V U I F S M B O E + \r ' J T D I F S & \r 4 L J O O F S + ( F U U J O H 1 B T U % F O J B M ± 5 I F ) J H I $ P T U P G ) F B M U I D B S F J O U I F 6 O J U F E 4 U B U F T New England Journal of Medicine \r 4 F Q U F N C F S \r 7 P M \r / P ( P P E P S 6 T F M F T T \r . F E J D B M 4 D B O T $ P T U U I F 4 B N F New York Times \r . B S D I \r 4 U V E E F S U % . \r . F M M P . . \r 4 B H F 8 . \r % F T 3 P D I F T $ . \r 1 F V H I + \r ; B Q F S U , \r # S F O O B O 5 " % F G F O T J W F . F E J D J O F " N P O H ) J H I S J T L 4 Q F D J B M J T U 1 I Z T J D J B O T J O B 7 P M B U J M F . B M Q S B D U J D F & O W J S P O N F O U Journal of the American Medical Association \r \n & O T V S J O H 2 V B M J U Z 5 I S P V H I " Q Q S P Q S J B U F 6 T F P G % J B H O P T U J D * N B H J O H \r 8 B T I J O H U P O \r % $ \r " N F S J D B µ T ) F B M U I * O T V S B O D F 1 M B O T \r . F S F O T U F J O % \r % B V N J U ( - \r 1 P X F / 3 6 T F B O E $ P T U T P G / P O S F D P N N F O E F E 5 F T U T % V S J O H 3 P V U J O F 1 S F W F O U J W F ) F B M U I & Y B N T American Journal of Preventative Medicine \r \n ) F B M U I 3 F G P S N µ T 5 B C P P 5 P Q J D % F G F O T J W F . F E J D J O F Washington Post + V M Z \r 8 F J O T U F J O
28 \r 4 " N F S J D B O " D B E F N
\r 4 " N F S J D B O " D B E F N Z P G 0 S U I P Q B F E J D 4 V S H F P O T " " 0 4 \n 5 I F $ P T U P G % F G F O T J W F . F E J D J O F Now / P W F N C F S 28 Where can $700 billion in waste be cut annually? ) F M M J O H F S ' + \r & O D J O P T B 8 & 5 I F * N Q B D U P G 4 U B U F - B X T - J N J U J O H . B M Q S B D U J D F % B N B H F " X B S E T P O ) F B M U I D B S F & Y Q F O E J U V S F T American Journal of Public Health \r " V H V T U \n & Q V C + V O 4 V Q Q M Z 4 F O T J U J W F $ B S F " % B S U N P V U I " U M B T 1 S P K F D U 5 P Q J D # S J F G + B O V B S Z 1 S F W F O U B C M F ) P T Q J U B M J [ B U J P O T " 8 J O E P X * O U P Q S J N B S Z B O E 1 S F W F O U J W F $ B S F \r " H F O D Z G P S ) F B M U I D B S F 3 F T F B S D I B O E 2 V B M J U Z \r / P \r 4 F Q U F N C F S , P [ B L - + \r 0 X J O H T . ' \r ) B M M . + " D B E F N Z G P S ) F B M U I 4 F S W J D F T 3 F T F B S D I B O E ) F B M U I 1 P M J D Z . F F U J O H / B U J P O B M 5 S F O E T J O 1 P U F O U J B M M Z " W P J E B C M F ) P T Q J U B M J [ B U J P O T " C T U S " D B E ) F B M U I 4 F S W 3 F T ) F B M U I 1 P M J D Z . F F U / B U J P O B M ) F B M U I D B S F 2 V B M J U Z 3 F Q P S U \r " ) 3 2 5 B C M F ) $ 6 1 4 U B U J T U J D B M # S J F G " Q S J M , S V [ J L B T % 5 \r + J B O H ) + \r 3 F N V T % \r # B S S F U U . - \r $ P G G F Z 3 . \r " O E S F X T 3 1 S F W F O U B C M F ) P T Q J U B M J [ B U J P O T " 8 J O E P X * O U P 1 S J N B S Z B O E 1 S F W F O U J W F $ B S F \r ) $ 6 1 ' B D U # P P L / P " ) 3 2 1 V C M J D B U J P O / P 3 P D L W J M M F \r . % " H F O D Z G P S ) F B M U I D B S F 3 F T F B S D I B O E 2 V B M J U Z \r " W P J E B C M F ) P T Q J U B M J [ B U J P O T J O 1 F O O T Z M W B O J B * T T V F # S J F G G S P N U I F 1 F O O T Z M W B O J B ) F B M U I D B S F $ P T U $ P O U B J O N F O U $ P V O D J M 1 ) $ \n / P W F N C F S $ I F O - 8 \r ; I B O H 8 \r 4 V O + \r . V F M M F S , + 5 I F . B H O J U V E F \r 7 B S J B U J P O \r B O E % F U F S N J O B O U T P G 3 V S B M ) P T Q J U B M 3 F T P V S D F 6 U J M J [ B U J P O " T T P D J B U F E 8 J U I ) P T Q J U B M J [ B U J P O T % V F U P " N C V M B U P S Z $ B S F 4 F O T J U J W F $ P O E J U J P O T Journal of Public Health Management and Practice \r \n " ) 3 2 µ T / F X 1 S F W F O U J P O 2 V B M J U Z * O E J D B U P S T ' M B H 1 P U F O U J B M M Z " W P J E B C M F ) P T Q J U B M J [ B U J P O T " ) 3 2 1 S F T T 3 F M F B T F / P W F N C F S \r ' M P S F T ( \r " C S F V . \r $ I B J T T P O $ & \r 4 V O % , F F Q J O H $ I J M E S F O 0 V U P G ) P T Q J U B M T 1 B S F O U T µ B O E 1 I Z T J D J B O T µ 1 F S T Q F D U J W F T P O ) P X 1 F E J B U S J D ) P T Q J U B M J [ B U J P O T G P S " N C V M B U P S Z $ B S F 4 F O T J U J W F $ P O E J U J P O T $ B O # F " W P J E F E Pediatrics / P W \n 9 J B P ) \r # B S C F S + \r $ B N Q C F M M & 4 & D P O P N J D # V S E F O P G % F I Z E S B U J P O " N P O H ) P T Q J U B M J [ F E & M E F S M Z 1 B U J
29 F O U T American Journal of Health-S
F O U T American Journal of Health-System Pharmacy % F D \n $ V M M F S 4 % \r 1 B S D I N B O . - \r 1 S [ Z C Z M T L J . ' B D U P S T 3 F M B U F E U P 1 P U F O U J B M M Z 1 S F W F O U B C M F ) P T Q J U B M J [ B U J P O T " N P O H U I F & M E F S M Z Medical Care + V O \n Where can $700 billion in waste be cut annually? 29 " N F S J D B O % J B C F U F T " T T P D J B U J P O & D P O P N J D $ P T U T P G % J B C F U F T J O U I F 6 4 J O Diabetes Care . B S \n " I F S O . . \r ) F O E S Z Y . " W P J E B C M F ) P T Q J U B M J [ B U J P O T G P S % J B C F U F T $ P N P S C J E J U Z 3 J T L T Dis Manag % F D \n . P S S J T - $ P N C B U J O H ' S B V E J O ) F B M U I D B S F " O & T T F O U J B M $ P N Q P O F O U 0 G " O Z $ P T U $ P O U B J O N F O U 4 U S B U F H Z Health Affairs \r O P E P J I M U I B G G ' S B V E . B Z " D D P V O U G P S 6 Q U P P G ) F B M U I D B S F 4 Q F O E J O H HealthLeaders Media + V M Z \r R V P U J O H G S P N B S F Q P S U G S P N 5 I F ( F P S H F 8 B T I J O H U P O 6 O J W F S T J U Z 4 D I P P M P G 1 V C M J D ) F B M U I B O E ) F B M U I 4 F S W J D F T * H M F I B S U \r + ' J O E J O H . P O F Z G P S ) F B M U I D B S F 3 F G P S N ± 3 P P U J O H 0 V U 8 B T U F \r ' S B V E \r B O E " C V T F New England Journal of Medicine + V M \n & Q V C + V O + V T U J D F % F Q B S U N F O U " O O P V O D F T - B S H F T U ) F B M U I D B S F ' S B V E 4 F U U M F N F O U J O * U T ) J T U P S Z 6 O J U F E 4 U B U F T % F Q B S U N F O U P G ) F B M U I B O E ) V N B O 4 F S W J D F T 1 S F T T 3 F M F B T F 4 F Q U F N C F S \r % B M M 5 . \r ' V M H P O J 7 - \r S E \r ; I B O H : \r 3 F J N F S T , + \r 1 B D L B S E 1 5 \r " T U X P P E + % 1 P U F O U J B M ) F B M U I # F O F ¾ U T B O E . F E J D B M $ P T U 4 B W J O H T ' S P N $ B M P S J F \r 4 P E J V N \r B O E 4 B U V S B U F E ' B U 3 F E V D U J P O T J O U I F " N F S J D B O % J F U American Journal of Health Promotion \n ' J O L F M T U F J O & " \r 5 S P H E P O + ( \r $ P I F O + 8 \r % J F U [ 8 " O O V B M . F E J D B M 4 Q F O E J O H " U U S J C V U B C M F U P 0 C F T J U Z 1 B Z F S B O E 4 F S W J D F 4 Q F D J ¾ D & T U J N B U F T Health Affairs (Millwood) \n X " O E F S T P O - ) \r . B S U J O T P O # $ \r $ S B J O " - \r 1 S P O L / 1 \r 8 I J U F C J S E 3 3 \r 0 µ $ P O O P S 1 + \r ' J O F - + ) F B M U I D B S F $ I B S H F T " T T P D J B U F E 8 J U I 1 I Z T J D B M * O B D U J W J U Z \r 0 W F S X F J H I U \r B O E 0 C F T J U Z Preventing Chronic Disease \n " $ P M E J U [ ( " & D P O P N J D $ P T U T P G 0 C F T J U Z B O E * O B D U J W J U Z Medicine & Science in Sports & Exercise 4 V Q Q M \n 4 8 B O H ( \r 1 S B U U . \r . B D F S B $ " \r ; I F O H ; + \r ) F B U I ( 1 I Z T J D B M " D U J W J U Z \r $ B S E J P W B T D V M B S % J T F B T F \r B O E
30 . F E J D B M & Y Q F O E J U V S F T
. F E J D B M & Y Q F O E J U V S F T J O 6 4 " E V M U T Annals of Behavioral Medicine \n $ % $ 1 S F T T 3 F M F B T F " Q S J M \r " S N P V S # 4 \r ' J O L F M T U F J O & " \r ' J F C F M L P S O * $ 4 U B U F - F W F M . F E J D B J E & Y Q F O E J U V S F T " U U S J C V U B C M F U P 4 N P L J O H Preventing Chronic Disease \n " 30 Where can $700 billion in waste be cut annually? 3 P T F O 4 . \r . J M M F S 5 3 \r 4 J N P O \r . 5 I F $ P T U P G " M D P I P M J O $ B M J G P S O J B Alcoholism Clinical and Experimental Research \n ( B S S F U U / " \r # S B T V S F . \r 4 D I N J U [ , ) \r 4 D I V M U [ . . \r ) V C F S . 3 1 I Z T J D B M * O B D U J W J U Z % J S F D U $ P T U U P B ) F B M U I 1 M B O American Journal of Preventive Medicine \n 5 I F $ P N N P E J U J [ B U J P O P G ) F B M U I D B S F & G G F D U T P G $ P N Q F U J U J P O P O 3 F J N C V S T F N F O U 3 B U F T \r . B O B H J O H U I F . B S H J O ) F B M U I D B S F ' J O B O D J B M . B O B H F N F O U " T T P D J B U J P O . B Z 3 F J O I B S E U 6 & \r ) V T T F Z 1 4 \r " O E F S T P O ( ' $ S P T T / B U J P O B M $ P N Q B S J T P O T P G ) F B M U I 4 Z T U F N T 6 T J O H 0 & $ % E B U B \r Health Affairs (Millwood) . B Z + V O \n " O E F S T P O \r ( ' \r 3 F J O I B S E U \r 6 & \r ) V T T F Z \r 1 4 \r 1 F U S P T Z B O \r 7 * U µ T 5 I F 1 S J D F T \r 4 U V Q J E 8 I Z 5 I F 6 O J U F E 4 U B U F T * T 4 P % J G G F S F O U ' S P N 0 U I F S $ P V O U S J F T Health Affairs W \r / P 4 # B M V & T U J N B U F E " O O V B M % J S F D U & Y Q F O E J U V S F T J O U I F 6 O J U F E 4 U B U F T B T B 3 F T V M U P G * O B Q Q S P Q S J B U F ) Z Q F S U F O T J P O 5 S F B U N F O U " D D P S E J O H U P / B U J P O B M 5 S F B U N F O U ( V J E F M J O F T $ M J O J D B M 5 I F S B Q Z \r \n ( S B C P X T L J % $ \r 0 µ . B M M F Z " + \r # B S I Z E U / 3 5 I F $ P T U T B O E 1 P U F O U J B M 4 B W J O H T " T T P D J B U F E 8 J U I / V S T J O H ) P N F ) P T Q J U B M J [ B U J P O T ) F B M U I " G G B J S T . J M M X P P E \n \n % B O [ P O \r 1 . \r ' V S V L B X B \r . ' 1 S J D F T B O E " W B J M B C J M J U Z 0 G 1 I B S N B D F V U J D B M T & W J E F O D F ' S P N / J O F $ P V O U S J F T ) F B M U I " G G B J S T 0 D U P C F S 8 F C & Y D M V T J W F 8 ABOUT THOMSON REUTERS Thomson Reuters is the world!s leading source of intelligent information for businesses and professionals. We combine industry expertise with innovative technology to deliver critical information to leading decision makers in the financial, legal, tax and accounting, healthcare and science and media markets, powered by the world!s most trusted news organization. With headquarters in New York and major operations in London and Eagan, Minnesota, Thomson Reuters employs more than 50,000 people and operates in over 100 countries. Thomson Reuters shares are listed on the Toronto Stock Exchange (TSX: TRI) and New York Stock Exchange (NYSE: TRI). thomsonreuters.comThomson Reuters777 E. Eisenhower ParkwayAnn Arbor, MI 48108 USAPhone +1 800 366 7526 "2009 Thomson Reuters. All rights reserved. TR-7261 10/09