It’s always a great comfort to know that one’s life, health and pocketbook are safe and secure in the hands of government and large corporations. Unlike the rest of us, these are people who have the time and money to study things thoroughly and know how to deal with problems. Like all of that troublesome “waste, fraud, and abuse” in the American healthcare system.
Of course, “waste” is a very different thing from “fraud”, and they’re both very different from “abuse”. But at least our government knows what and where they all are, and what to do about them. President Obama said so in the speech he gave to Congress in September. When describing where all of the money to pay for his party’s massive healthcare “reform” plan would come from, he assured America’s beloved taxpayers and overseas creditors that:
“…Most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care don’t make us any healthier. That’s not my judgment — it’s the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid.”
That’s great news, because it means that our leaders know how much waste and abuse there is, where to find it and how to stamp it out. Otherwise how could they use the savings to pay for anything? The other wonderful thing is that his speech gives us the definitive and presidential definition of “waste”. Waste consists of “dollars we spend on health care that don’t make us any healthier.” There’s a good, sound, verifiable definition if there ever was one.
All of which brings us to the topic of circumcision.
One of the big trends in healthcare over the past twenty years has been the exponential growth of programs designed to provide “oversight”, “quality” and “performance” to a healthcare system infested by derelict doctors and nurses. These “quality” initiatives are invented by both government regulators and private businesses eager to carve out their niche in a growth industry.
One of these private organizations is the enormously powerful non-profit Joint Commission. As stated on its website (http://www.jointcommission.org) , the Commission’s job is to “help health care organizations help patients”. In practice, this involves collecting many millions of dollars in fees in exchange for surveying and inspecting the various hospitals, clinics, labs and other facilities who wish to be accredited and certified. The stakes for those seeking accreditation or certification are high – many insurers, and state and government agencies require that healthcare facilities be Joint Commission accredited or certified as a condition of doing business. Many hospitals and other facilities will do almost anything to garner and maintain Joint commission approval.
So what happens when “quality and oversight” precipitate “waste”?
Dr. Anna Meenan, was lucky enough to find out. As a family doctor in an Illinois hospital, Dr. Meenan frequently pulls duty in the circumcision room next to labor and delivery. The room is a simple affair, dedicated to circumcisions and outfitted only with a steel table, sink, overhead light and a counter and cupboard containing circumcision supplies. As part of a quality initiative (almost certainly precipitated by some sort of bad mix-up that happened in a real operating room), the Joint Commission decided that all fluids on any sterile field must be rigorously labeled. Although circumcisions are done under mostly sterile conditions, there are only two fluids used in the process: soap and water. These are, of course, used for washing off the little boy’s private parts prior to performing the operation. One dips a cotton ball or piece of gauze in the water and then in the soap (or vice versa), scrubs the little bugger, and then it’s on to business at hand.
At Le Cirque du Circ, everyone wears a hat like this...
With the advent of the new Joint Commission rule, that simple routine became more elaborate. Now, before Dr. Meenan or anyone else can do a circumcision, the medical technician must don sterile gloves, and peel open a package containing six sterile labels and a sterile pen. He or she then writes the words “soap” and “water” on two of the labels, peels them off and sticks them to each side of the divided dish that will hold the soap and water. The previously sterile pen and remaining labels are then thrown away. The technician then checks a box in a new “Fluids Labeled” column added to the log sheet. The log is then routinely checked by a quality control nurse who is hired to make sure that all of the boxes are filled in. If a sterile pen doesn’t happen to be available when the circumcision is supposed to be done, the procedure has to be postponed until one can be located. All of this happens for each of the two to ten circumcisions that are done each day.
While only a curmudgeon (or possibly an accountant) could begrudge the cost of the sterile pen, six labels and five minutes of total staff time to a good cause, it’s pretty clear that the overly broad implementation of this safety guideline is a bona fide source of wasteful healthcare spending. It’s hard to conceive of a circumstance in which labeling circumcision soap and water has improved the healthcare of anyone. And while it’s just a drop in the proverbial bucket, drops have a way of adding up. After all, Dr. Meenan’s hospital is only one of thousands who collectively perform almost 900,000 circumcisions in the United States every year. If we conservatively assume that a sterile pen pack costs $1 and that hospital technicians earn $20 per hour, then simple math tells us that we’re spending roughly $3.4 million each year on Joint Commission-mandated labeling of soap and water. Not a lot of money, really. Just enough to insure 250 American families each year. Fortunately, the folks in the government probably already know about this particular source of waste, and are planning to stamp it out any day now, right?
Well no, and we’ll explore why in my next post. But in the meantime, does anyone need about a million slightly used pens?
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