Medicare pays many hospitals and their physicians more than the most efficient and effective healthcare institutions to treat chronically ill people, yet gets worse results, according to a new report from the Dartmouth Institute for Health Policy and Clinical Practice. This problem is particularly serious because caring for people with chronic disease now accounts for more than 75 percent of all healthcare spending.
The new edition of the Dartmouth Atlas of Health Care, Tracking the Care of Patients with Severe Chronic Illness, shows that institutions that give better care can do it at a lower cost because they don’t overtreat patients. Getting usage under control is the most critical factor in controlling costs, says the report. The researchers, for instance, discovered great variations in the number of services that patients with severe chronic disease receive at the end of life, depending on the hospital, region, or state--and not on how sick they are.
For example, an elderly person spent an average 10.6 days in the hospital during the last two years of life in Bend, Ore., but 34.9 days in Manhattan. The variation is even more striking in the last six months of life, when chronically ill patients visited physicians an average of 14.5 times in Ogden, Utah, compared with 59.2 times in Los Angeles.
That creates wide variations in how much Medicare spends on these patients. The U.S. average was $46,412. The highest spending was in New Jersey at $59,379 per patient, or a quarter more than the average. The lowest was in North Dakota at $32,523 per patient, or a quarter less than the average. Download the report.
