title: Small Ideas for Saving Big Health Care Dollars.
abstract: A focused review of recent RAND Health research identified small ideas that could save the U.S. health care system $13 to $22 billion per year, in the aggregate, if successfully implemented. In the substituting lower-cost treatments category, ideas are to reduce use of anesthesia providers in routine gastroenterology procedures for low-risk patients, change payment policy for emergency transport, increase use of lower-cost antibiotics for treatment of acute otitis media, shift care from emergency departments to retail clinics when appropriate, eliminate co-payments for higher-risk patients taking cholesterol-lowering drugs, increase use of $4 generic drugs, and reduce Medicare Part D use of brand-name prescription drugs by patients with diabetes. In the patient safety category, ideas are to prevent three types of health care-associated infections: (1) central line-associated bloodstream infections, (2) ventilator-associated pneumonia, and (3) catheter-associated urinary tract infections; use preoperative and anesthesia checklists to prevent operative and postoperative events; prevent in-facility pressure ulcers; use ultrasound guidance for central line placement; and prevent recurrent falls. Small ideas do not require systemic change; thus, they may be both more feasible to operationalize and less likely to encounter stiff political and organizational resistance.
authors.forename: Jodi L
authors.initials: JL
authors.lastname: Liu
authors.forename: Deborah
authors.initials: D
authors.lastname: Lai
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Ringel
authors.forename: Mary E
authors.initials: ME
authors.lastname: Vaiana
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wasserman