Older patients with similar chronic conditions receive treatment that varies widely, even among the top-ranked hospitals, according to studies released Thursday that suggest more expensive and frequent intervention does not make for better care.
“No matter how pre-eminent the institution, the care varies all over the ballpark,” said Dr. John Wennberg of the Dartmouth Medical School.
He was lead author of one of the studies, available at the online edition of the journal Health Affairs, about variations in medical practices.
Wennberg looked at Medicare claims during patients’ last six months of life from hospitals ranked by U.S. News & World Report as the best for geriatric care.
Among the findings:
- Medicare patients at New York’s Mount Sinai Medicare Center were in the hospital almost twice as long as those treated at the Mayo Clinic’s St. Mary’s Hospital in Rochester, Minn.
- At the 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 in Boston.
- Patients at both Mount Sinai and UCLA had twice as many visits from doctors as those at Duke University Hospital in Durham, N.C.
A study by Elliott Fisher of the VA Medical Center in White River Junction, Vt., said there is evidence that the most intense care for terminally ill patients actually could hasten death.
Taken together, the reports suggest that, despite published rankings, the best hospitals are the ones that deliver care more efficiently, typically through fewer hospitalizations and doctor visits.
Wennberg said one remedy would be to tie Medicare reimbursement to performance. Last year’s Medicare prescription drug law took a small step in that direction by linking a small portion of payments to hospitals to their willingness to provide measures of the quality of their care.