Chronically Ill Patients Get More Care, Less Quality, Says Latest Dartm...( The Fix? A Major Overhaul of Medi...),Health

The Fix? A Major Overhaul of Medicare

LEBANON, N.H., April 7, 2008 /PRNewswire-USNewswire/ -- Medicare pays many hospitals and their doctors more than the most efficient and effective health care 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.

If the U.S. health care system mirrored the practice patterns of gold-standard health care systems such as the Mayo Clinic in Minnesota, Medicare could save tens of billions of dollars annually. Those savings would come just when Medicare needs that money most, as baby boomers prepare to retire in droves, putting unprecedented pressure on the health-care system.

"This report demonstrates the need to overhaul the ways we care for Americans with chronic illness," said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. "The extent of variation in Medicare spending, and the evidence that more care does not result in better outcomes, should lead us to ask if some chronically ill Americans are getting more care than they or their families actually want or need."

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 over-treat patients. However, the Atlas documents that Medicare and most other payers encourage the over-use of acute-care hospital services and the proliferation of medical specialists thanks to misplaced financial incentives, especially for treating chronically ill people.

This is a serious problem. Caring for people with chronic disease now accounts for more than 75 percent of all health-care spending. And over-use and overspending is not just a Medicare problem--the health-care system as a whole lacks efficient, effective ways of caring for people with severe chronic
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