Large hospital-by-hospital variations in the intensity with which hospitals treat their seriously ill patients is found not only for patients covered by fee-for-service (FFS) Medicare, but also for those covered by Medicare health maintenance organizations (HMOs) and for nonelderly patients with private insurance. Moreover, hospitals that frequently hospitalize their FFS Medicare patients are also often the same hospitals that have high levels of resource use for other types of patients as well, according to a study of treatment provided by California hospitals to patients with chronic illnesses in their last two years of life. The study, supported by the California HealthCare Foundation, was published Feb. 12 on the Health Affairs web site.
In line with earlier research, the researchers observed wide variation between hospitals in the intensity of treatment provided to Medicare FFS beneficiaries. There was a fivefold difference between the average number of days used by patients associated with the highest-use hospital (47) and the average number of days used by patients associated with the lowest-use hospital (9). Sizable variations in treatment intensity also existed among Medicare HMO, private preferred provider organization/FFS, and private HMO patients. In all three insurance groupings, there was at least a twofold difference in total days used by patients associated with the highest- and lowest-use hospitals. Read the abstract.
