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Fraud Waste and Abuse (FWA)

Finding ways to reduce healthcare waste is part of effective care.

The unsustainable rise in healthcare costs can be directly linked to waste-related spending; in fact, waste may account for nearly one-third of all health spending in the United States. By becoming more aware of waste, we have the ability to help patients, their families, and ourselves.
Waste involves practices that are inconsistent with sound fiscal, business, or medical practices. Waste is almost always an unconscious action, rather than intentional misuse.

Waste raises costs for insurance companies and for patients. This reduces Medicare Trust Funds, increases taxes, and lowers our revenue.

All this results in public loss of confidence in healthcare programs, forcing increased government regulations. Reducing waste can help save an estimated 30% of spending without worsening health outcomes for patients.

But how do you go about cutting waste? Start by simply being aware that waste is an everyday occurrence, regardless of your role. Think about your day-to-day contributions and ask yourself how you can implement best practices into your routine to reduce waste.

Some important questions to ask yourself are:

  • ​Am I addressing patient’s preventative care and safety? Stopping issues before they appear contributes to reducing patient injuries, preventing worse health outcomes, and eliminating higher costs.
  • ​Am I coordinating care appropriately? Poorly managed care can create unnecessary readmission or complications that can threaten patient health.
  • ​Do I have a conflict of interest? Performing healthcare actions that are motivated by something other than the care of the patient is wasteful and unethical.
  • ​Am I over-treating the condition? Actions taken to defend against malpractice lawsuits, over-diagnose, or provide for intensive end-of-life care when alternative care is suggested by the family adds up to billions in wasted healthcare dollars.
  • ​Can I reduce complexity? The interactions between health insurance providers, accreditation agencies, and the government can create excessively bureaucratic processes.

Reducing Waste

It takes an informed and committed team of healthcare practitioners and analysts. Here’s how the players can help:

Healthcare analysts should ask questions like:

  • ​Are there specific items that can be decreased in cost?
  • ​Can we reduce the number of procedures?
  • ​Can we acquire test results faster?
  • ​Do we have duplicate orders?

With this data, clinical staff:

  • ​Establish best practices.
  • ​Standardize care models that can be observed and measured for impact.
  • ​Implement revised standards based on these measurable findings.
  • ​Create benchmarks that routinely capture ideal measurements.
  • ​Continue to track and adapt to new data findings.

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