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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People who are part of the Deferred Action for Childhood Arrivals program, known as DACA, will be dropped from their CoveredCA health plans at the end of August.

The move comes after the Trump administration changed a Biden-era definition of "lawfully present" to revoke health care eligibility for thousands of immigrants.

Christine Smith, policy and legislative advocate for the nonprofit Health Access California, said people only have a few weeks to get medical appointments in before their coverage ends.

"If you're enrolled in Covered California and you're a DACA recipient, the Trump administration just ended your coverage," Smith emphasized. "People should use as much of your health care as you can before the August 31st deadline."

The Centers for Medicare and Medicaid Services defended the move, saying it will save taxpayers money. CoveredCA estimated the change affects about 2,400 DACA recipients in the state who make too much to qualify for Medi-Cal and have jobs not providing health insurance. They can still buy private insurance but it is much more expensive. People who prepaid for their coverage can seek a refund.

Smith predicted it will be a blow not just to those who lose coverage but to the state's health care system as a whole.

"The lines in the ERs are going to be longer because people are not going to be able to get affordable preventive care," Smith projected. "They're just going to get sicker and then end up in the ERs. People will overall incur more medical debt. Hospitals will have more uncompensated care."

The change is nationwide. As of mid-July, about 538,000 people in the DACA program across the U.S. are ineligible to enroll in any state-based insurance marketplace and are unable to access premium subsidies or cost-sharing assistance.

Artificial intelligence is appearing more prominently in many aspects of life and research suggests older populations are curious, yet remain wary of using the technology in their everyday lives.

According to Stats Indiana, there are more than 1.5 million Hoosiers aged 65 and older, or 18% of the state's population. Experts said it is likely the demographic will use AI in some form in the next few years, either by choice or necessity.

Dr. Shaun Grannis, vice president of data and analytics for the Regenstrief Institute on Aging, said AI offers real benefits.

"It can reduce loneliness through conversation, provide reminders for medications and appointments," Grannis outlined. "It can support cognitive stimulation via games, storytelling, news updates."

The technology can also offer a low-pressure way to access information on public services, he added, which is valuable for those with mobility issues or those who feel intimidated by technology.

Grannis cautioned any tool which can be used for good can also lead to problems. He noted AI can create a false sense of companionship and mask social isolation. Overdependence is a legitimate concern, he argued, if the technology becomes a "crutch" for all forms of interaction.

"All cognitive activities or decision-making, it can actually lead to and create a negative feedback loop, lead to a decline in engagement and even basic self-management skills," Grannis explained. "This is risky."

Grannis believes one solution is designing AI systems to complement, not replace, human interaction. He stressed it can be done though building broader support ecosystems including family, friends, caregivers and community services. Grannis emphasized it would encourage real-world activity, prompting the user to go for a walk, call a grandchild or attend a local senior event.

If you have an extra five minutes, you can save a life because you can learn cardiopulmonary resuscitation at no cost from a new mobile, hands-only CPR kiosk.

The new kiosk is in the lobby of Saint John's Health Center in Santa Monica. The machine's touch screen gives a brief overview of hands-only CPR and you can practice right there, on a mannequin.

Dr. Rigved Tadwalkar, cardiologist at St. John's, said it is an easy way for people to get more comfortable giving chest compressions in an emergency.

"It's a lot like a video game but of course, a lot more important than a video game," Tadwalkar pointed out. "It gives real-time feedback about the depth and rate of compressions, proper hand placement, which are all factors that influence the effectiveness of CPR."

The American Heart Association operates the St. John's mobile kiosk and a stationary model at L-A-X with support from the hospital. Santiago Canyon College in Orange County also has a mobile hands-only C-P-R kiosk now through September, sponsored by Edwards Lifesciences.

Steven Munatones, an Orange County business owner, said he survived what's known as a "widowmaker" heart attack which led to cardiac arrest nine years ago, thanks to his 17-year-old son, who gave him immediate CPR with instructions from a 911 operator.

"You don't have to put your mouth to anybody's mouth," Munatones explained. "You just put your hand on their chest and pump. He saved me, and others can do the same, anywhere. So, it's absolutely a lifesaving, heroic act that anybody can do."

Statistics show 350,000 Americans suffer from cardiac arrest outside a hospital each year and about 90% die, in part because they do not receive CPR. About 70% of those cardiac arrests happen at home, so people often depend on family or friends to give CPR before an ambulance arrives.