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Letter to the Editor, Editorial Address Study on End-of-Life Hospital Spending for Medicare Beneficiaries

Two newspapers on Thursday published a letter to the editor and an editorial about a recent study conducted by researchers at the Dartmouth Institute for Health Policy and Clinical Practice that found wide variations among the top U.S. academic medical centers in spending on care for Medicare beneficiaries with chronic conditions during the last two years of their lives. Summaries of the letter and editorial appear below.

Jim Jaffe, Baltimore Sun: The study has prompted some observers to question the efficiency of the health care system, but the problem "isn't that expensive hospitals charge more for a given test or procedure, but rather that they do a lot more of them" and "fewer marginal ones," Jaffe, public affairs vice president for the Center for the Advancement of Health, writes in a Sun opinion piece. According to Jaffe, "Raising this issue at a time of economic stress highlighted new data showing that job growth in America today is basically confined to the health and education sectors," which "raises a red flag about the painful cost of imposing efficiencies in these areas despite chronic and growing public concerns about rising bills." Lawmakers "are sensitive to the human cost of creating a more efficient medical system, but they seldom speak of it," Jaffe writes, adding, "Instead, they speak in general terms about reform and tend to focus on the need to expand services for the uninsured and to help the insured pay their bills" (Jaffe, Baltimore Sun, 4/10).

New York Times: The "reason for the disparities" found in the study is "not that one hospital charges a lot more for a given service than the others" but that "high-cost hospitals provide a lot more services for patients than the lower-cost hospitals: keeping patients in the hospital and in intensive care for longer periods, sending them to a slew of specialists and doing a lot more tests and procedures," a Times editorial states. "No doubt the high-cost institutions think they are 'going the extra mile' for their patients, but some patients don't want such aggressive care, and most don't experience any health benefits from it," the editorial states, adding, "Few will be surprised to discover that doctors in high-expenditure institutions are typically paid on a fee-for-service basis, which means they earn more if they do more." According to the editorial, "Reducing the cost of medical care will require changing longstanding habits -- no easy feat" -- and that "may not happen until the medical profession reaches consensus on which treatments will truly improve the health of patients and which are superfluous" (New York Times, 4/10).


April 10, 2008
Editorial

Quality Care at Bargain Prices

When politicians talk of reforming the health care system to rein in costs, skeptical patients often worry that they will be forced to accept shoddy treatment in second-rate institutions. So it is a relief to learn that the famed Mayo Clinic in Minnesota and the renowned Cleveland Clinic in Ohio offer outstanding care at bargain prices — at least compared with higher-priced, equally prestigious medical centers elsewhere.

The comparison comes via the latest edition of the Dartmouth Atlas of Health Care, published by Dartmouth’s Institute for Health Policy and Clinical Practice. Researchers there have long pointed to large disparities in medical spending in different areas of the country and shown that patients usually do no better — and often fare worse — where the spending is highest.

This year’s atlas focuses on Medicare spending for patients in the last two years of life at the top five teaching hospitals, as ranked by U.S. News & World Report. The medical center at the University of California, Los Angeles, was the most extravagant, averaging some $93,000 per patient. Johns Hopkins, at $85,000, and Massachusetts General, at $78,000, came next. The Cleveland Clinic, at $55,000, and the Mayo Clinic, at $53,000, were far more cost-effective.

READ more


baltimoresun.com
Editornial: Health care fix may hurt city

By Jim Jaffe

April 10, 2008

..

News this week that treating a dying Medicare patient at the Johns Hopkins Hospital costs 60 percent more than care at the Mayo Clinic - without yielding any extra health benefits - prompted Congressional Budget Office Director Peter R. Orszag to suggest health care may be "the least efficient sector of our economy."

The problem isn't that expensive hospitals charge more for a given test or procedure, but rather that they do a lot more of them. Efficiency means doing fewer marginal ones.

Raising this issue at a time of economic stress highlighted new data showing that job growth in America today is basically confined to the health and education sectors. That raises a red flag about the painful cost of imposing efficiencies in these areas despite chronic and growing public concerns about rising bills.

READ more