Hospitals that treat patients more intensively and spent more Medicare dollars did not get better results, according to a new study by the Center for the Evaluative Clinical Sciences at Dartmouth Medical School. The Dartmouth Atlas Project compiled a database of claims data for 4.7 million Medicare enrollees who died during the period of 2000 to 2003 and had at least one of 12 chronic illnesses and were treated at one of 4,300 hospitals in 306 regions. The database allows, for the first time, a comparison of how states, regions, and individual hospitals and associated physicians treat patients with chronic illness.
The study found that patients in regions with low-cost, high-quality care --such as Salt Lake City, Utah; Rochester, Minn.; and Portland, Oreg.--are admitted less frequently to hospitals, spend less time in intensive care units, and see fewer specialists. If over the four-year period, every hospital and all physicians used practice patterns like those in Salt Lake City--primarily based on care provided by Intermountain Healthcare--the $123 billion Medicare spent for these patients would have been reduced by $40 billion, nearly one-third. The study report calls for a reimbursement system that rewards, rather than penalizes, provider organizations that successfully reduce excessive use of services, and proposes that hospitals take leadership in redesigning how they care for the chronically ill. The study also emphasizes the need for academic medical institutions and federal agencies, such as the National Institutes of Health, to perform patient-level studies to produce detailed evidence defining efficient clinical practices.
