SEATTLE — In a single year, more than 600,000 Washingtonians underwent treatment they didn't need, according to a new analysis.

In the Washington Health Alliance report First, Do No Harm: Calculating Health Care Waste in Washington State, researchers found people spent more than $280 million on unnecessary treatments or examinations between July 2015 and June 2016.

The WHA notes three ways this harms patients: physically, emotionally and financially. Report author and WHA Deputy Director Susie Dade says financial harm isn't talked about as much as the other two, but medical debt is is a major issue. Nationally, nearly one in five Americans has medical debt in collection.

"When they are faced with a decision to pay down debt or send their kids to school or to college, to what kind of housing they can afford - whether they can afford their rent," she says. "Whether or not they can afford to go to the doctor. Whether or not they can afford to pay for a recommended medications or tests or procedures. All of these things come into play."

The report analyzed the insurance claims of 1.3 million patients for 47 commonly-overused treatments, which are identified by groups such as the U.S. Preventive Services Task Force. Of those, 11 approaches were most prevalent, including cervical screenings that were too frequent, antibiotic prescriptions, and lab studies prior to low-risk surgeries.

Dade says there isn't a single reason for the surplus of unneeded care, but a "more is better" approach is pervasive in the health-care system, and both providers and patients fall into this trap. The fee-for-service model that dominates health care also is a factor in overuse.

Dade advises patients to ask five questions about any new procedure or treatment, starting with its necessity, its risks or side-effects, and the possibility of safer options.

"Number four is, 'What happens if I don't do anything?'" she suggests. "What happens if I just take a wait-and-see approach for a little while? What are the risks and benefits of doing nothing? And then, finally, 'How much is this going to cost me and will my insurance pay for it?'"

On the other side, Dade says, providers should look at evidence-based guidance such as the recommendations from the clinician-led "Choosing Wisely" initiative.

She also says tools such as electronic medical records can be used to alert providers when they order a treatment option that isn't evidence-based.


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A diagnosis of diabetes increases the risk of heart disease, stroke, kidney disease and even death.

The School of Public Health at Indiana University-Indianapolis is close to completing a project to improve the health of three neighborhoods. The Diabetes Impact Project works in the Northeast, near Northwest, and Near West neighborhoods in Indianapolis, where rates of diabetes are almost double other parts of Marion County.

Lisa Staten, associate professor of community and global health at the university, said the project's three-tier approach involves community health workers assisting people with diabetes in managing their diet and glucose monitoring, while also addressing their social needs.

"The community health workers work with them to understand, is there a food security issue? Are there challenges with housing?" Staten explained. "We also have neighborhood community health workers that are located in these three parts of the city, to help raise awareness about diabetes prevention and diabetes risk."

The third tier, which Staten described as the most direct, is made up of steering committees, funding projects to improve physical activity infrastructure and healthy food access, address mental health concerns and build social connections. According to the Indiana Department of Health, about 12% of Hoosiers are diabetic.

The $12 million eight-year program is a partnership with the Fairbanks School of Public Health, Eli Lilly and Company, Eskenazi Health and the Marion County Health Department. One component was to have a federally qualified health center located in each of the areas for more community-based involvement.

Staten pointed out diverse neighborhood input was sought prior to the project's funding.

"We approached community residents and asked what they wanted to see in it," Staten recounted. "They said they don't want a one-year project. 'We don't want you to come in and take our data and go. It needs to be a long-term commitment.' And we listened to that and incorporated all that into it."

Despite the pandemic, which happened during the project, Staten added the researchers were able to continue their work. The findings will be published in academic journals and public forums for the community to see its impact.


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A North Carolina woman is speaking out about the importance of the Affordable Care Act and the Inflation Reduction Act.

DonnaMarie Woodson, who battled cancer during the 2008 recession when her husband lost his job, credits the Affordable Care Act for providing vital health insurance for her family. Enrolling in the federal program allowed Woodson to undergo regular screenings, leading to the early detection of colon and breast cancer.

Now, Woodson is urging lawmakers to protect important health care programs.

"The Affordable Care Act literally saved my life," Woodson asserted. "Because I would not have gone to get screened because of medical debt."

She pointed out the Inflation Reduction Act has also had a profound effect on her family, particularly in managing her husband's Type 1 diabetes. She said the measure's insulin cap helped reduce the cost of his medicine from $200 to $35. It has made a significant difference for their fixed income household.

According to Tufts University, the Affordable Care Act has been challenged in court more than 2,000 times. The Inflation Reduction Act has also met its
fair share of pushback and votes to repeal different provisions in the law.

Woodson argued if the programs are not protected, it could pose severe risks to people across the country.

"People's lives are at stake. People will die," Woodson stressed. "That is a plain fact without health care, quality affordable care, not just in your care but quality affordable care. People need that and it's a right."

Today, Woodson's story extends beyond her personal experiences. She actively works with the American Cancer Society Cancer Action Network to lobby for health care rights, emphasizing the necessity of maintaining and expanding health care programs. She encouraged others to share their own experiences in their communities and make their voices heard by local leaders.


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In rural Tennessee, many residents lack access to healthy, fresh, and affordable food. So, two health center systems in the state are sprouting solutions - with community garden programs.

Aura Sheran - a certified clinical medical assistant with East Tennessee State University's Johnson City Community Health Center - said the garden connects patients, the community, and volunteers - which fosters a collaborative effort to address food insecurity and promote healthier choices.

"We serve a lot of the community, that don't have enough funds to purchase produce and that kind of thing, food wise," said Sheran. "So, it helps them to cut some of that cost back, and to take some produce home and share with their family."

Community health centers serve more than 423,000 patients across Tennessee, regardless of their insurance status or ability to pay.

Nicole Vanover is a phlebotomist with Ballad Health who provides lab services to the ETSU clinic.

She said community partners - like the Appalachian Resource Conservation and Development Council, which runs a food access program - help to provide resources, and vendors provide funding and equipment.

"Tractor Supply - both the Johnson City Tractor Supply and the Jonesborough Tractor Supply store - each donated about $150 to $200 worth of products," said Vanover. "That was soil, fertilizer, tomato cages, things like that."

She added that the garden flourishes with the support of volunteer ETSU students who help maintain it, and clear the beds at the end of each growing season.

Cherokee Health Systems maintains legacy gardens at its Alcoa, Maynardville, and New Tazewell health centers.

Ginny Weatherstone, community development consultant with Cherokee, said the gardens serve as community spaces where patients can interact.

And they honor the memory of former CEO - Dr. Dennis Freeman, who had a passion for gardening from his Iowa farm upbringing.

"Growing things was something that he did growing up, and it was always near and dear to his heart," said Weatherstone. "He got sidetracked there, leading a rather large organization for over 40 years, and always in the back of his mind had the idea of community gardens that would serve our patients."

Weatherstone pointed out that participants also learn about gardening in Cherokee Health Systems' psychiatric day-treatment program.

So, the garden serves a dual purpose - providing fresh fruits and vegetables for patients, and helping people with mental illness learn how to cope.

"We really do believe that these gardens are an important part of the day treatment program. They are scheduled now into the the daily activity, the list of things that are going to be done," said Weatherstone. "There is nothing like a bowl of fresh strawberries to just really make somebody feel good about what they've been able to accomplish."




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