Medicare Spending Varies by State

Medicare spends tens of thousands of dollars more in some states than in others to provide care for beneficiaries with chronic illnesses, but the increased spending does not result in longer life for beneficiaries or higher satisfaction with their quality of care, according to a study released on Tuesday by the Dartmouth Atlas Project, USA Today reports. For the study, Dartmouth Medical School researchers examined records of hospital care, tests and physician visits provided to 4.7 million Medicare beneficiaries during the last two years of their lives.

Study participants were ages 67 and older and had at least one of 12 chronic illnesses (Appleby, USA Today, 5/16). Study participants died between 2000 and 2003 (Feldstein, St. Louis Post Dispatch, 5/16).

According to the study, Medicare spent the most on average -- $39,810 -- to provide care for participants in New Jersey, followed by the District of Columbia, California and New York. Medicare spent the least on average -- $23,697 -- to provide care for participants in Idaho, followed by Iowa, West Virginia and North Dakota, the study finds (USA Today, 5/16).

Participants in New Jersey had the highest average number of physician visits during the last six months of their lives at 41.5, and those in Utah had the lowest average number at 17, according to the study. In addition, the study finds that participants in Hawaii spent the highest average number of days in the hospital during the last six months of their lives at 16.4 and that those in Utah spent the lowest average number at 7.3.

For each chronic illness, the study finds higher mortality rates among participants who received the most care (Freking, AP/Long Island Newsday, 5/16).

According to the study, participants during the last six months of their lives were hospitalized or placed in an intensive care unit five times more often at some major academic hospitals than at others, and Medicare spent twice as much to provide care for participants during the last two years of their lives at some facilities than at others. The study finds that participants at New York University Medical Center spent the highest average number of days in the hospital during the last six months of their lives at 32.1, compared with an average of 12.9 days for those at St. Mary's Hospital, a Mayo Clinic facility.

The study also finds that participants at the University of California-Los Angeles Medical Center spent an average of 11.4 days in the intensive care unit during their last six months of their lives, compared with an average of 3.3 days for those at UC-San Francisco Medical Center. In addition, the study finds that Medicare spent an average of $79,280 to provide care for participants during the last two years of their lives at NYUMC, compared with an average $37,271 to provide care for those at the Mayo Clinic (Winslow, Wall Street Journal, 5/16).

Jack Wennberg, principal researcher of the study and director of the Center for Evaluative Clinical Services at Dartmouth Medical School, said, "Things are actually worse in regions that spend more money and have higher utilization." Wennberg added, "Patients don't benefit -- they can't be rescued -- and the costs of such care are very high, both in dollars spent and in providing care that the majority of chronically ill patients might not want, such as admissions to intensive care and being sent to specialist after specialist."

Nancy Chockley, president of the National Institute for Health Care Management, said, "I think this is one of the most important studies to come about this year. Shame on all of us if we don't act on this."

Peggy O'Kane, president of the National Committee for Quality Assurance, said, "The people who pay the bills need to stand up and say, 'Enough of this, this is not the way we want to use our health care dollars'" (St. Louis Post-Dispatch, 5/16).

Helen Darling, president of the National Business Group on Health, said that the study "is evidence that we are wasting hundreds of billions of dollars that we need to be spending on the people who don't get the care they need, not on people who don't need the care they're getting."

Sen. Max Baucus (D-Mont.) said, "These new findings remind us yet again that we need to start paying for quality -- not just quantity -- in Medicare," adding that the program requires a "sensible and sustainable payment policy for the future" (Carey, CQ HealthBeat, 5/15).

However, Clay Dunagan, vice president for quality at BJC HealthCare, said that the study does not take "everything into account."

Dartmouth on Tuesday plans to release Dartmouth Atlas Project data on 4,300 U.S. hospitals in 306 regions on the project Web site, www.dartmouthatlas.org (St. Louis Post-Dispatch, 5/16).

Elliott Fisher, a professor of medicine at Dartmouth, said, "These data allow patients, purchasers (such as insurers and Medicare) and policy makers to see what's happening to patients with chronic illness." Fisher added that differences among hospitals can have "huge implications for what patients pay in terms of their copayments" (Wall Street Journal, 5/16).