Urban, Rural Hospitals Divided Over Efforts To Control Health Spending
Congress' attempts to address regional differences in the cost and intensity of care have pitted urban hospitals, which tend to have high spending rates, against rural hospitals, which often have lower costs, the New York Times reports.
Research from Dartmouth Medical School's Institute for Health Policy and Clinical Practice indicates large differences in the level and cost of care provided in different geographic regions.
For example, Medicare spending was $65,000 higher at New York University's Langone Medical Center than at Genesis Medical Center in Davenport, Iowa, during the last two years of a patient's life. Patients at the Iowa hospital also saw 48 fewer physicians than patients at the New York hospital during the last six months of life.
Evidence suggests better patient outcomes in lower-spending regions, the researchers note.
Provisions in Reform Legislation
A provision in the House health reform bill (HR 3962) would require the non-partisan Institute of Medicine to conduct a two-year study of regional disparities in Medicare spending. IOM would then provide recommendations about how best to remedy those disparities.
Unless Congress objected to those recommendations by May 31, 2012, they would automatically take effect.
Senate reform legislation would penalize doctors who order a high number of tests but would compare each physician against other physicians from the same geographic region, Sen. Charles Schumer (D-N.Y.) has said.
Proponents of addressing regional spending differences say that greater efficiency in Medicare could cut spending by 15% to 30%.
According to researchers from Dartmouth Medical School, lowering Medicare's annual growth in per patient spending from the current national average of 3.5% to 2.4% could save $1.42 trillion by 2023.Opponents argue that cutting Medicare payments to areas with the fastest growth in costs benefits affluent, rural hospitals and hurts urban hospitals, which must contend with higher levels of poverty and costs of living (Hartocollis, New York Times, 11/3). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.