Quality of Care Varies Widely at Top-Ranked Hospitals, Health Affairs Studies Find
Medicare patients with chronic illnesses receive "significantly different" levels of treatment in hospitals ranked "best" by U.S. News and World Report, according a new study published Thursday, the Atlanta Journal-Constitution reports (Maltin, Atlanta Journal-Constitution, 10/7). The study is part of a package of 20 new Health Affairs web exclusive articles examining variations in medical practice.
Taken together, the studies "show that a higher intensity of care and higher level of spending are not associated with better quality or longer survival times even in the most renowned teaching hospitals," according to a Health Affairs release. In one study, researchers from Dartmouth Medical School examined the treatment of 90,616 Medicare beneficiaries older than age 65 with solid tumor cancers, congestive heart failure or chronic obstructive pulmonary disease during their last six months of life at 77 hospitals deemed "best" for geriatric care and treatment of heart and pulmonary disease by U.S. News and World Report (Health Affairs release, 10/7).
The researchers found "wide gaps in care," the Journal-Constitution reports. According to the studies, the biggest variations included how often physicians visited patients, the number of diagnostic tests conducted and how often patients were admitted to a hospital or an intensive care unit. The best hospitals used fewer resources and provided fewer hospitalizations and physician visits for Medicare beneficiaries with chronic illnesses, according to John Wennberg, director of Dartmouth's Center for the Evaluative Clinical Sciences and lead author of the study (Atlanta Journal-Constitution, 10/7).
Other findings include:
- Medicare patients at Mount Sinai Medical Center were hospitalized almost twice as long as those treated at Mayo Clinic's St. Mary's Hospital;
University of California-Los Angeles Medical Center patients spent three times as many days in the intensive care unit as those at Massachusetts General Hospital;
- Patients at Mount Sinai and UCLA Medical Center had twice as many visits from doctors as those at Duke University Hospital (AP/Detroit News, 10/7).
- Patients at UCLA Medical Center were more likely to see a primary care physician than patients at St. Louis University or Mount Sinai Medical Center; and
- UCLA patients had 2.8 times more specialist visits than with primary care physicians (Carey, CQ HealthBeat News, 10/7).
In another study, Dartmouth researchers looked at patients initially hospitalized for heart attack, colorectal cancer or hip fracture at one of 299 hospitals belonging to the Council of Teaching Hospitals. Researchers examined practice patterns, quality of care and patient outcomes and found "no association between higher intensity of care and improved survival," according to a Health Affairs release (Health Affairs release, 10/7). Moreover, the study showed that a "very high intensity of care for people with certain terminal medical conditions might hasten death," CQ HealthBeat News reports (CQ HealthBeat News, 10/7).
Wennberg suggested that Medicare reimbursements be tied to performance (AP/Detroit News, 10/7). Wennberg said, "The significance of these findings is that for the first time we can use Medicare claims data to measure the performance of individual hospitals and identify those hospitals that appear to be doing a better job managing chronic illness and patient care." He added, "The studies prove that no matter how pre-eminent the institution, the care varies all over the ballpark" (Atlanta Journal-Constitution, 10/7). Elliott Fisher of the Veterans Affairs Outcomes Group, co-author of the second study, said, "We know hospitals are dangerous places. Higher intensity patterns of practice are associated with no better quality and, if anything, worse quality" (Connolly, Washington Post, 10/8).
CMS Administrator Mark McClellan on Thursday said he would test the studies' results by implementing new forms of payment in the Medicare system. However, he said that such a system "will only pay when quality improves and costs decline" (Rovner, CongressDaily, 10/8). Leonard Schaeffer, CEO and chair of WellPoint Health Networks, which helped fund the studies, said, "This research should serve as a wake-up call to all health plans that we have a collective responsibility to drive quality and cost transparency in medical care. Health plans must intensify their efforts to integrate the data they are capturing every day and turn it into information that transforms the American health care system" (Atlanta Journal-Constitution, 10/7). The studies are available online.