Managed Care - July 2008 - (Page 55) PLAN WATCH busy. Physicians adapt their practice subliminally to the available resources.” Spending less for high quality The fee-for-service system and medical ou might think that some hospitals in higher-spending regions culture ensure that available capacity, for spend more for mediocre care because they do not follow bestboth hospital beds and physician services, practice guidelines. Dartmouth researchers tested for this as well by is utilized, the study says. “When patients comparing the best academic medical centers around the country. experience acute episodes of their underThey found that the Mayo Clinic and the Cleveland Clinic spend lying chronic illnesses, most physicians less per capita than other top-notch institutions while still scoring continue to believe that more intensive high on quality. “Other academic medical centers use far more resources, deliver care is better; the availability of inpatient far more supply-sensitive care, and cost significantly more per capita, beds makes the use of the hospital the path but with no better quality.” of least resistance, even when other sites of care are in place,” the study states. Variations in cost at the best medical institutions Goodman says that this issue cuts to Spending, resource use, and utilization of services by Medicare health plans’ efforts to purchase services beneficiaries with chronic illness cared for at five “honor roll”* academic medical centers (deaths occurring 2001–2005). with the best value. “Typically this is done at present by just Inpatient Hospital looking at the cost of a single health care payment per days per Payment event, such as an episode of surgery,” says decedent decedent per day Goodman, “where our [Dartmouth’s] emJohns Hopkins Hospital $59,759 28.6 $2,093 phasis has been on the efficiency of the UCLA Medical Center $58,557 31.3 $1,871 longitudinal care of patients.” Massachusetts General Hospital $38,844 28.9 $1,344 The study tracks the difference in care Mayo Clinic $31,816 21.3 $1,497 for patients with chronic disease in which Cleveland Clinic $31,252 23.9 $1,307 the outcomes are known, saying that “by * These are the five academic medical centers that U. S. News & World Report looking at care delivered during fixed inplaced at the top of its 2007 Honor Roll of America’s Best Hospitals. tervals of time before death, we can say with assurance that the prognosis of all Source: “Tracking the Care of Patients With Severe Chronic Illness,” Dartmouth Atlas of Health Care 2008, April 2008 the patients is identical: All were dead after the interval of observation.” Says Goodman: “A great deal of variation in hospital,” says Goodman. “Being in the hospicost was found. So selective purchasing or dital can be a great benefit for the right patient, recting patients to more efficient providers over but has its obvious downsides. More and more, time would have great potential for saving there are concerns about hospital-acquired inmoney. At the same time, there doesn’t need to fections, medication errors. No one should be interested in exposing patients to hospital enbe any sacrifice in terms of quality of care. The vironments when good alternatives exist.” MC emphasis on costs longitudinally for chronic illness is very important for plans and payers to ADVERTISING INDEX pay attention to. Health plans should want to contract with FOREST LABORATORIES MEDIMMUNE, INC. hospitals that place more emphasis on ambuBystolic 9–10 Synagis C3,C4 Lexapro 27–29 latory care, says Goodman. Insurers should SANOFI-AVENTIS, U.S. GENOMIC HEALTH worry less about the price of a day’s stay at a cerManaged Care 21 Oncotype DX 35 tain hospital. Instead, they should concern HEALTH DIALOG TEVA HEALTH SYSTEMS themselves with whether it is an institution Health Plans 13 Epoprostenol 3 where there is a high predilection for hospitalMDDATACOR ization in the first place. UCB, INC. Quality Improvement “There’s been a robust literature indicating Solutions C2 Cimzia 37–42 that many patients will do just as well not in the Y JULY 2008 / MANAGED CARE 55
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