By David Stern

The fight over healthcare is entering a new round. Most Americans agree that we need more affordable insurance and coverage of pre-existing conditions. With Scott Brown's victory in the special election for the late Sen. Ted Kennedy's Massachusetts seat, Washington's political order has been revamped. Accordingly, debate on how to provide these benefits and otherwise improve the system has begun anew.

Whenever something more on healthcare happens in Congress"and whatever it is"it should result from a more business-like approach. To date, reform has been a one-size-fits-all, one-shot deal, trying to be everything to everybody. In contrast, corporate entities launch products and services based on extensive research of what the market will bear. New offerings serve a targeted customer base. Marketers anticipate that even their latest products might need to be improved quickly to meet the market's needs cost-effectively.

While there is no easy answer for healthcare, a simple business principle can be followed: "leave no stone unturned." Every opportunity to control Medicare and Medicaid expenses while maintaining quality care needs to be pursued. Even the most ardent opponents of reform agree with that.

No one wants to decrease caregiver-patient interaction. Or prevent anyone from receiving the medical tests, hospital stays, or treatments they need. Rather, the focus should be on healthcare administration, to reduce the cost of facilitating these.

For example, Comerica Bank recently unveiled electronic payment processing capabilities for healthcare providers. The bank estimates that nearly one third of every healthcare dollar is spent on paperwork and other labor-intensive administrative costs.

Another sure route to savings the healthcare industry can follow: local outsourcing. Hospitals, skilled nursing facilities, and other healthcare operations can find others to do jobs for them outside the purview of healthcare services.

According to a Modern Healthcare magazine survey, contracting for accounts-receivable functions has recently spiked. Big savings are also realized by outsourcing laundry, housekeeping, clinical equipment maintenance, emergency department and foreign-language-training staff, and call centers.

Individually, new cost controls need not be earth-shattering. Shifts that save individual providers thousands of dollars per year can add up to hundreds of millions or billions throughout the nation. Good targets are custodial services, purchasing, patient-care and medical/surgical supplies, and cafeterias. Disposable foam mattresses, for instance, can be almost entirely replaced with permanent waterproof mattresses. At Legacy Good Samaritan Hospital, Portland, Ore., this decision paid for itself in just one year with about $81,000 in savings.

Taking stock of personal-care items provided to patients (aspirin packets, tissues, shampoo, diapers, baby wipes) helps, too. Often, they don't use all of these, and when they check out, leftovers are trashed. At Butterworth Hospital, Grand Rapids, Mich., following infection control guidelines, nursing staff now evaluates these. This has saved an estimated $30,000 per year.

Outsourcing laundry produces more substantial savings. It's also better for the environment. Outside commercial operations that wash linen and garments use natural resources most efficiently. We offer huge economies of scale in production because we have a large client base. Compared with hospital-operated standalone linen washrooms, our high-capacity machinery does a far better job of conserving water, energy, chemistry, and other supplies.

Relatively speaking, waste reduction and outsourcing are small steps in a long trek. But they are no less necessary. The healthcare industry needs more of every flavor of fundamental business ingenuity, such as subjecting all kinds of contracts to competitive bidding. Dramatically streamlining administration is probably America's best shot at providing truly cost-effective care.

Congress can help by encouraging more attention to the little things. As a taxpayer, I just wish our Representatives and Senators would make better use of the present healthcare debate by spending as much time looking for ways to save as to how to spend.

David Stern is president and CEO of Paris Healthcare Linen Services, which serves Northeast Ohio from Ravenna.