This final article in this series brings up an important distinction; there is a major difference between a bad outcome and negligence. Even with sound procedures and diligence, sometimes bad outcomes occur – but they do not constitute malpractice. We could save a large portion of the $420 billion mentioned in the first article if attorneys would stop trying to talk patients into ignoring the difference.

Many politicians tout EHR (Electronic Health Records) as a way to reduce costs and improve patient safety. In principle, we support EHR. The problem is with implementation. Currently, there is no uniform platform or infrastructure to support a standardized EHR system. Proposals are being discussed to require standards ahead of EHR implementation. But what about currently deployed systems? Some fear the creation of a hodge-podge of systems that cannot effectively communicate with each other. Our history is full of well-intended legislation that created more problems than were solved. Thus the cliché, “I’m from the government, I’m here to help.” Let’s hope that the costs don’t outweigh the savings.

Another area of waste is the pressure to discharge patients prematurely. As Dee Swanson, president of the American Academy of Nurse Practitioners, points out, discharging patients too soon is a “huge waste of money.” Patient non-compliance also affects readmission rates. Too often, patients don’t follow the doctor’s discharge instructions – landing back in the hospital later with complications. PricewaterhouseCoopers estimates that preventable hospital readmissions cost some $25 billion a year.

Sanitation is another big cause of unnecessary loss. Some $3 billion a year could be saved, if we’d just avoid preventable infections. What would it take to make that change? Basics like regular washing of hands can make a big dent in the problem. Believe it or not, sometimes the answer is just that simple.

The last aspect of waste may be the most important of them all. Risky behaviors like smoking, obesity and substance abuse costs nearly half a TRILLION dollars! Bad outcomes may be unavoidable but behavior is something we can change, both socially and individually. As we look for ways to make healthcare affordable for everyone, perhaps this the best area upon which to focus.

Nearly a trillion dollars a year can be saved if we can affect these conditions and enact real tort reform. And that is A LOT of zero’s.