End-of-Life Spending Varies Widely for Medicare
Patients with Chronic Conditions
New Jersey spent most, $59,379; North Dakota least,
$32,523; US average $46,412 - Kaiser Network Daily Report
April 7, 2008- There is wide variation among the
U.S.'s top academic medical centers in spending on care for Medicare
beneficiaries with chronic conditions during the last two years of their
lives, according to the 2008 edition of The Dartmouth Atlas of Health
Care, the
New York Times reports (Pear, New York Times, 4/7).
All of the beneficiaries had
at least one chronic health condition. The study compared the length of
hospitalization, the number of physicians treating a beneficiary and the
amount of time beneficiaries spent in intensive care units during the
last two years of their lives (Appleby,
USA Today, 4/7).
The study focused on the top five teaching
hospitals, as ranked by
U.S. News & World Report (New York Times, 4/7). Care for
beneficiaries with chronic illnesses during the last two years of their
lives accounts for about one-third of all Medicare spending (Francis,
Wall Street Journal, 4/7).
Findings
The study found that spending at teaching hospitals
for the last two years of beneficiaries' lives cost an average of
$67,369 per beneficiary (USA Today, 4/7). University of California-Los
Angeles
Medical Center spent the most per beneficiary at $93,842, and the
Mayo Clinic spent the least at $53,432. UCLA was followed by
Johns Hopkins Hospital at $85,729 per beneficiary;
Massachusetts General Hospital at $78,666; and
Cleveland Clinic Foundation at $55,333 (New York Times graphic,
4/7).
The study also found that New Jersey spent the most
on end-of-life care for Medicare beneficiaries at $59,379, compared with
the national average of $46,412 per chronically ill beneficiary. Three
dozen states spent below the national average, with North Dakota
spending the least at $32,523 per beneficiary.
Study co-author Elliott Fisher, a Dartmouth medical
professor and director of its Center for Healthcare Research and Reform,
said that costs tended to be higher at facilities where more treatment
options were available. In addition, an effort to reduce costs by
shifting care to rehabilitation centers, nursing homes and home health
care does not appear to be effective, according to the study.
Researchers projected that Medicare could have
saved $50 billion from 2001 to 2005 if care at all hospitals across the
U.S. were on par with per-beneficiary spending of Rochester, Minn.,
where the Mayo Clinic is based. Study co-author David Goodman, a
Dartmouth pediatrics professor, said that Mayo Clinic and Minnesota
served as benchmarks for high-quality, efficient care (Wall Street
Journal, 4/7).
The researchers said the findings show that
policymakers need to focus on volume as a cost-containment measure, not
just the price of a particular treatment or expanding health insurance
to all U.S. residents (Freking,
AP/San Francisco Chronicle, 4/7).
Comments
Lead study author John Wennberg of
Dartmouth Medical School said, "Some chronically ill and dying
Americans are receiving too much care -- more than they and their
families actually want or benefit from" (Dow
Jones/Chicago Tribune, 4/7). Wennberg added, "Contrary to popular
assumptions, it's the volume of services, not the price per service,
that accounts for most of the variation in Medicare spending" (New York
Times, 4/7).
Nancy Foster, the
American Hospital Association's vice president of quality and
patient safety, said the study triggers the question of how much overuse
is driven by hospitals and physicians and how much is because "patients
want and require more care, and when that's available, take advantage of
it" (Wall Street Journal, 4/7).
J. Thomas Rosenthal, chief medical officer at UCLA
Medical Center, said, "Some of the aggressive care saves lives," adding,
"The Dartmouth study does not ferret that out in a systematic way."
Denis Cortese, president of Mayo Clinic, said, "Our
physicians are all salaried. They have no financial incentive to do more
than is necessary for the patient. In each case, multiple doctors and
nurses make decisions collaboratively with the patient and family
members. We really try to understand the patient's wishes for
end-of-life care."
Congressional Budget Office Director Peter Orszag commented on the
wide difference in costs at top-ranked hospitals, saying, "How can the
best medical care in the world cost twice as much as the best medical
care in the world?"(New York Times, 4/7).
>> A summary of the report is available
online (.pdf).
April 7, 2008- There is wide variation among the
U.S.'s top academic medical centers in spending on care for Medicare
beneficiaries with chronic conditions during the last two years of their
lives, according to the 2008 edition of The Dartmouth Atlas of Health
Care, the
