Chronically Ill Patients Not Receiving Consistent Care
May 28, 2008
The Dartmouth Atlas of Health Care, a biennial report on the use of medical resources, recently released findings on Medicare spending of chronically ill patients in the last 2 years of their lives. The report, titled "Tracking the Care of Patients with Severe Chronic Illness," shows how care varies across states, regions, and hospitals.
The Dartmouth Atlas studied the records of millions of Medicare enrollees with chronic illnesses who died between 2001-2005 and found that more care does not always equate to better care. Noting an overuse of acute-care services, the Dartmouth Atlas shows that it is not the cost of services driving cost variation, but rather the number of specialists seen and the days spent in the ICU. Variation is evident, not simply relative to how sick the patients were, but also in relation to the hospital, region or state. This disparity is particularly poignant in the last 6 months of life.
The Mayo Clinic was used as the "gold standard" for efficient and effective care, to which other hospitals were compared. The Dartmouth Atlas showed that healthcare spending is related to the supply of beds and access to specialists, not how sick the patients were. In this way, regions with more resources often use more beds and specialists and, as a consequence, have higher costs. As an example, the Mayo clinic spent half as much per patient than the UCLA medical center, on similar patients in similar time frames. Furthermore, chronically ill patients treated at UCLA had two times as many physician visits as those treated at the Mayo Clinic. UCLA patients also spent 50% more days in the hospital in their last 6 months of life, as compared to Mayo Clinic patients. These are important statistics, as America's aging population reaches the age for Medicare eligibility, and when considering quality of life in the finals years of life and the choice to die at home.
The Dartmouth Atlas illustrates a lack of expert consensus on how to properly treat and manage chronically ill patients. Healthcare spending is NOT explicitly tied to quality. In fact, those states that used more services per patient actually showed slightly worse levels of quality care. Therefore, by focusing on quality, rather than what often turns out to be the overuse of available resources, the Medicare system could save remarkable amounts of money, all while providing better care for the patient. The report states that Medicare could have saved $50.1 billion if the national average spending per patient mirrored that at the Mayo Clinic, seen as the optimal provider of care.
