LEBANON, NH – According to a report by the Dartmouth Institute for Health Policy and Clinical Practice, Medicare pays many hospitals and their physicians more than the most efficient and effective healthcare institutions to treat chronically ill people, yet gets worse results.
The report, which was in the latest edition of the Dartmouth Atlas of Health Care: Tracking the Care of Patients with Severe Chronic Illness, focused on supply-sensitive care for Medicare beneficiaries who had serious chronic illnesses and were in their last two years of life.
Lead author John Wennberg and colleagues Elliott Fisher, MD, David Goodman, MD, and Jonathan Skinner studied chronically ill patients based on the fact that a third of Medicare dollars each year is spent on them during the last two years of life.
The report defines supply-sensitive care as services where the supply of a specific resource has a major influence on use rates. Physician visits, hospitalizations, stays in intensive care units and imaging services are all examples of care where the local supply influences the frequency of use.
Researchers found variations in the number of services that chronically ill patients received at the end of life depending on the hospital, region or state, rather than how sick they were.
When medical decisions are more open, admission rates are strongly correlated with the local supply of hospital beds. And in regions with more physicians, the frequency of visits to physicians is higher, the report says.
This results in wide variations in how much Medicare spends on these patients, says the report. While the U.S. average was $46,412, $59,379 was spent per patient in New Jersey, while in North Dakota $32,523 was spent per patient.
“This report demonstrates the need to overhaul the ways we care for Americans with chronic illness,” said 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.”