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In the Substituting Lower-Cost Treatments Category, These Ideas Would Provide the Following Estimated Annual Savings in Millions of 2012 U.S. Dollars (Ranges Indicate Lower and Upper Bounds)

• Reduce use of anesthesia providers in routine gastroenterology procedures for low-risk patients ($1,200).
• Change payment policy for emergency transport ($290–$580).
• Increase use of lower-cost antibiotics for treatment of acute otitis media ($36).
• Shift care from emergency departments to retail clinics when appropriate ($3,500 [$1,200–$4,400]).
• Eliminate co-payments for higher-risk patients taking cholesterol-lowering drugs ($1,300).
• Increase use of $4 generic drugs ($5,900 [$4,900–$6,800]).
• Reduce Medicare Part D use of brand-name prescription drugs by patients with diabetes ($1,500).

In the Patient Safety Category, These Ideas Would Provide the Following Estimated Annual Savings in Millions of 2012 U.S. Dollars (Ranges Indicate Lower and Upper Bounds)

• Prevent three types of health care-associated infections: (1) central line-associated bloodstream infections ($18 [–$55–200]), (2) ventilator-associated pneumonia ($47 [–$5–$110]), and (3) catheter-associated urinary tract infections ($100 [–$88–$170]).
• Use preoperative and anesthesia checklists to prevent operative and postoperative events ($170 [–$110–$950]).
• Prevent in-facility pressure ulcers ($2,400 [$1,600–$4,400]).
• Use ultrasound guidance for central line placement ($56).
• Prevent recurrent falls ($900).

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.

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