Hospitals that provide more intensive and costly care do not provide better-quality care, and hospitals that spent the most often deliver the worst care, says a new study recently published on the Health Affairs web site. The study examined care given to Medicare beneficiaries for acute myocardial infarction, pneumonia, and congestive heart failure and is one of the first nationwide analyses of quality and spending at the individual hospital level.
The authors found that average end-of-life (EOL) spending was $16,059 for the lowest-spending quintile of hospitals and $34,742 for hospitals in the highest-spending quintile. Hospitals that spent more actually performed worse on overall quality measures than lower-spending hospitals. When the analysis was limited to academic medical centers, there was no positive association between quality and spending. The only statistically significant finding was a negative relationship between EOL spending and the quality of treatment for heart attacks.
When each hospital was compared only to others in the same region, the negative correlation between EOL spending and the quality of treatment for heart attacks was eliminated, but strong negative correlations remained between spending and the quality of treatment for pneumonia. “This shows that the failure of higher-spending hospitals to produce better care reflects more than the fact that quality is not higher in higher-spending regions. Within each region, some hospitals are able to do more with less, achieving better quality while spending fewer dollars,” said the researchers.
