Dr. Rosenthal collaborated with colleagues at U.C.L.A. and four other medical centers and found that for elerly heart failure patients, the hospitals that spend the most seem to save the most lives.
These results reveal one of the fundamental flaws in the cost saving approach of the Obama Administration with Medicare. Looking at health care costs in areas of the US where the population is healthier, the end of life costs are lower does not prove that the lower cost areas are more efficient health care systems. It simply reflects socioeconomic differences between patients in the poorer sections of Los Angeles and those in the Mayo Clinic’s small and solidly middle-class areas like Rochester, Minnesota. Rochester has lower costs because their patients do not have as many health problems as those in Los Angeles, they have longer life spans and they cost less money to the healthcare system long before they come to the ends of their longer lives. It's apples and oranges. You take poor people who smoke too much, drink too much, exercise too little, have poor nutrition and live in a high stress urban environment, they are going to be more expensive to keep alive in their final years. No big surprise -- except to the paper pushers in Washington D.C. who live in an Ivory Tower apart from the real world.
But the Obama Administration health 'experts' feel they can impose a 'one size fits all' approach to end of life care: less testing, less intensive management and less money for the very sick elderly.
I discussed this earlier on DU and I still think the Obama people have a blind spot here:
Why President Obama Can't Use Green Bay & Lacrosse to Project Healthcare CostsYet that ethos has made the medical center (UCLA) a prime target for critics in the Obama administration and elsewhere who talk about how much money the nation wastes on needless tests and futile procedures. They like to note that U.C.L.A. is perennially near the top of widely cited data, compiled by researchers at Dartmouth, ranking medical centers that spend the most on end-of-life care but seem to have no better results than hospitals spending much less.
Listening to the critics, Dr. J. Thomas Rosenthal, the chief medical officer of the U.C.L.A. Health System, says his hospital has started re-examining its high-intensity approach to medicine. But the more U.C.L.A.’s doctors study the issue, the more they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.
By some estimates, the country could save $700 billion a year if hospitals like U.C.L.A. behaved more like Mayo (Clinic). High medical bills for Medicare patients’ final year of life account for about a quarter of the program’s total spending.
Under the House health care legislation pending in Congress, the Institute of Medicine would conduct a study of the regional variations in Medicare spending to try to determine how to reward hospitals like Mayo for providing more cost-effective care. Hospitals identified as high-cost centers might even be penalized, perhaps receiving lower payments from the government. The Senate bill calls only for studies of Medicare spending variations, so it will be up to House-Senate negotiators to resolve the matter in the final legislation.
Weighing Medical Costs of End-of-Life Care
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