Deloitte study highlights CAM as major portion of “hidden costs of healthcare for consumers”  The consulting firm Deloitte announced in late May 2011 publication of a study that “aims to capture all health related spending.” The firm notes that official

    Deloitte study highlights CAM as major portion of “hidden costs of healthcare for consumers”    

The consulting firm Deloitte announced in late May 2011 publication of a study that “aims to capture all health-related spending.” The firm notes that official National Health Expenditure Accounts (NHEA) do not capture many health expenditures. The study, entitled The Hidden Costs of Health Care for Consumers: A Comprehensive Analysis, found that actual costs in 2009 were at $2.83-trillion. This is roughly $357-$363-billion or 14% higher than official estimates. The Deloitte team “adopted a broad view of health care expenditures which includes both direct and indirect costs, as well as items such as functional foods and nutritional supplements, complementary and alternative medicine (CAM) goods and services.” An estimated $55-billion were supplement costs, $28-billion CAM practitioner costs and $2-billion other CAM costs. Together these amounted to 24% of the “hidden costs.” The CAM practitioner portion was estimated at $92 per capita.




 Estimated Direct Annual Costs for Certain CAM-Related Services  



Age Group


 Nutritional Products*  


  CAM Practitioner Costs 


 CAM ProductsCosts 





























65 plus








* Category includes functional foods and special health-related drinks.


Source: The Hidden Costs of Health Care for Consumers: A Comprehensive Analysis 
Deloitte Development, LLC, 2011, page 18.


An additional category, “the imputed value of unpaid supervisory care provided to sick people by family and friends” was estimated to be the single largest cost not included in NHEA reporting, at $199-billion. One of the two lead authors is Paul Keckley, PhD, former CAM/integrative medicine lead at Vanderbilt University. (Thanks to Taylor Walsh for the heads-up on this study.)

Comment: These data are most useful as a general awareness that US consumers spend even more on health-related care than the the already horrendously high costs. They are casting a wide note. For instance, inclusion of all nutritional drinks (Ensure, etc.) jacks the “Nutritional Products” category up significantly. 


New Yorker economics writer aims cost-cutting guns at providers  

“Discussions of health care in the United States usually focus on insurance companies, but, whatever their problems, they’re not the main driver of health care inflation: providers are.” The deadpan conclusion is the centerpiece of a column by the New Yorker’s budget and debt journalist James Surowiecki. The column in the May 2, 2011 edition is entitled Bitter Pills. “One’s person’s ‘waste,'” Surowiecki adds, “is another person’s ‘income’ – the income of doctors, nurses, hospitals, drug companies, medical technology makers.” And: “If we want to restrain the growth of health-care spending, less money will have to go to them.” He concludes by stating that an ideal system “would guarantee all senors affordable health care, stop the debt from getting out of control and keep paying health providers as before.” But: “The problem is, you can only do two of those things at once.” 

Comment: I reference Surowiecki’s comment because it is my perception, also, that insurers are often made the scapegoats on health costs when more attention deserves to be focused on practitioners. No one much likes to think that one’s provider’s economic interests is a major player in clinical decisions and thus health care costs. The findings of Wennberg and others tell us we should. We certainly don’t like to think it is our doctors. I saw an ophthalmologist recently for a second opinion regarding an eye issues related to an old basketball injury. She recommended a surgery. I said I knew that the Institute of Medicines has said some 50% of what we do is waste and much of that harmful. In which category is your recommendation, I asked her. How to win friends.


Chiropractor Hamm elected co-chair of powerful AMA payment committee   

Anthony Hamm, DC, president of American Chiropractic Association’s Council of Delegates, was recently elected co-chair of the American Medical Association’s (AMA) Health Care Professionals Advisory Committee Review Board (HCPAC). According to a release from the American Chiropractic Association, Hamm is the first doctor of chiropractic to be elected to the position. As HCPAC co-chair, Hamm will also serve on the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The HCPAC develops recommendations on relative values for new and revised CPT codes for non-MD/DO services. The RUC makes annual recommendations on relative values regarding to the Centers for Medicare and Medicaid Services (CMS), 90% of which are adopted. The RUC also performs broad reviews every five years of the Resource-Based Relative Value Scale (RBRVS), which determines Medicare provider reimbursement. Hamm’s two-year term begins in September. Hamm brings a long policy and teaching background relative to coding to his new position. According to the release, the ACA “strongly supported Dr. Hamm’s nomination to this position given his clinical and socioeconomic experience and expertise in making appropriate recommendations for CPT codes across specialties.”  ACA President Rick McMichael, DC added: “This historic event is consistent with the ACA’s commitment to the delivery of high quality the heads-up on this news.)

Comment: Since my exploration of the value of the CPT to the AMA last year, which also touched on the powerful RUC, I had been surprised that no one has mounted an anti-trust case against the AMA’s guild control of payment. (See The AMA’s $70-Million Taxation without Representation: Is it Time for a “CPT Party” Revolt?). Hamm’s elevation may be viewed as an interesting chess move.