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Chronically Ill Patients Get More Care, Less Quality, Says Latest Dartmouth Atlas
Date:4/7/2008

illnesses.

Lead author Dr. John Wennberg and colleagues Elliott Fisher, M.D., M.P.H.; David Goodman, M.D., M.S.; and Jonathan Skinner, M.A., Ph.D., studied chronically ill patients

because a third of Medicare dollars each year are spent on them during the last two years of life. Two-thirds of the people in the study were diagnosed with cancer, congestive heart failure and/or chronic lung disease.

The newest Atlas is an important policy guide as the government struggles to rein in Medicare spending which, like health care spending overall, is expected to double over the next decade. Latest estimates predict health care spending will reach $4 trillion annually by 2017.

Wennberg called for a crash program to learn how leading organizations such as Mayo use fewer resources and spend less per capita than their peers while receiving high marks on quality measures. "Medicare policy, including reimbursement, should support "organized" systems of effective care management, with a strong primary care component," Wennberg said. "The federal government should also support better research into clinical practices for managing chronically ill patients."

It isn't so much what each medical service costs, the report says; it is how many services doctors prescribe. So getting usage under control is the most critical factor in controlling costs

The researchers, for instance, discovered staggering 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 the doctor an average of 14.5 times in Ogden, Utah, compared to 59.2 times in Los Angeles,
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SOURCE Dartmouth Atlas Project
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