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

Calif.

That creates wild 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.

"We need to benchmark the best systems and use policy to drive providers toward the benchmark by holding them accountable for the volume of services they deliver," said study co-author, Dr. Elliott S. Fisher, director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.

What's more, the Atlas research shows that hospitals, regions and states that use more services per patient do not necessarily have higher quality care. In fact, it is slightly worse.

The Dartmouth Atlas Project studied the records of millions of Medicare enrollees who died from 2001 to 2005 and had at least one of nine severe chronic illnesses. Using those records, researchers benchmarked care nationally to the care provided in the region where Mayo has its flagship clinics and is far and away the dominant health care provider. Total spending for the population in this study was $289 billion over the five years. If the spending per patient everywhere mirrored that in Mayo's home region of Rochester, Minn., Medicare could have saved $50.1 billion, or 17.3 percent of all spending on these patients alone. A benchmark to a higher cost but efficient region such as Sacramento, Calif., where labor costs are the 26th highest of the 306 regions, shows Medicare would still have saved $28.9 billion.

The study paints a picture of a system in disarray over the treatment of these illnesses. There are no good, clear guidelines for when to hospitalize these patients, admit them to intensive care, refer them to medical specialists or--for most conditions--when to order diagnostic or imaging tests.

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SOURCE Dartmouth Atlas Project
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