According to a recent Vanderbilt University Medical Center study, hospitals that spend more on emergency care tend to have better patient outcomes, including fewer deaths.
After looking at Medicare ambulance and hospital data between 2002 and 2008, Vanderbilt’s John Graves, assistant professor of preventive medicine, along with colleagues from the Massachusetts Institute of Technology and Cornell University, found that higher-spending hospitals had significantly lower patient mortality for emergency patients than their lower-spending counterparts.
“What we find is that higher-spending hospitals do see better mortality outcomes after one year. And when we dig deeper, we find that this is driven partially by whether you go to a teaching hospital, or a hospital that adopts the latest technology. But really, what drives the finding in our sample of emergency patients is the intensity with which you are treated upon arriving at the hospital,” said Graves. “But we also find that after a point, the returns diminish - and, in some of the highest spending hospitals, doing more actually is associated with worse mortality outcomes.”
Treatment in a teaching hospital reduced the risk of death within one year by four percent, while the most technologically advanced hospitals conferred a 4.7 percent risk reduction. High levels of initial treatment intensity in emergency situations conferred the most protection, reducing risk by 18 percent.
The research runs counter to current thinking, which suggests hospitals that spend the most on Medicare patients have no better outcomes and no better patient satisfaction than hospitals that spend less, or even much less.
Graves said there are two major barriers to studying the relationship between hospital spending and outcomes: high-cost hospitals also tend to treat higher acuity populations, which skews outcome comparisons; and spending is driven by myriad factors, all of which could be associated with better or worse outcomes at the patient level like teaching status or whether the hospital is run inefficiently.
“Our study provides a new lens to overcome these barriers to consider the returns to medical care. In contrast to previous research comparing patients across high- and low-spending regions, we essentially compare patients who are neighbors: they come from the same small geographic area or ZIP code, but are taken to different hospitals in an emergency because of the ambulance that picks them up,” said Graves.
Graves said his study doesn’t discount the idea there is wasteful spending in the healthcare industry, but it does provide evidence that some hospitals spending more on acute or emergent care can have better survival outcomes.
“An inefficient hospital, a high-acuity hospital and a technologically-advanced hospital all will exhibit high-cost structures, and each may or may not be better at saving lives,” Graves said. “The challenge is being able to ‘unbundle’ the complex cost-mortality association and pinpoint areas that can be improved upon to lower costs without harming quality.”
Graves said the paper is important because it shows a creative approach can remove major barriers to more accurate cost-effectiveness research.
“In the future we plan to use this approach so that we can better identify areas where greater emphasis should be put,” he said.
Follow HFN Associate Editor Kelsey Brimmer on Twitter @kbrimmerhfn.