Projected Federal Spending Under One Fiscal Scenario
Because health care is so large, instead of doing an analysis of the entire Federal budget, CBO decided to just do an analysis of healthcare. This chart essentially represents as best as I can tell from this CBO report, a “compilation” of sorts of the 115 scenarios involving changes to the federal health problems.
However (and I think this is very relative), this chart and analysis was done prior to the bank bailout and the auto bailout which in aggregate represent about one year’s worth of health care (slightly under 1 trillion for the current bailouts which approximates what we spend on health care in one year).
Amongst the options, cuts in payments to providers, end to fee for service, utilization of a “medical home” concept where the primary care doc can be more efficient with referrals (not a joke), and adjustments to the SGR, oh-and lots of way to expand the CMS program are also included (only the government health care system thinks they can expand benefits while decreasing costs).
An “EBP approach” is mentioned which would cost $860 million to research and then would save 1.3 billion. Higher pre-cert requirements for imaging, according to their estimates, would save 1.1 Billion.
There appears to be huge savings in health information technology-to the tune of $22.8 Billion. This nebulous category and savings “guess” is lost on me in comparison to what the pale savings by other measures mentioned (including their EBP guess). The savings cited include reduction in administrative costs, reduced number of inappropriate tests and procedures, and reduced paperwork. There are incentives for physicians to participate and penalties for non-participation. (note for file: have never seen reduction in paperwork with more automation).
In addition, there is no “analysis” of legal reform or referral for profit measures in this 235 page document which would be “low hanging fruit” for savings in my opinion. All in all, mostly old ideas repackaged and they never seem to understand that incremental savings out of providers pockets reduces access to services as more providers just simply limit the number of medicare patients in their practice.
