New Dartmouth Atlas of Health Care finds great variation in health care and costs with no better out

The latest edition of the Dartmouth Atlas of Health Care confirms that there is great variation in the delivery of health care to Medicare patients with chronic conditions and patients in the last two years of life.  This variation results in a wide range in health costs.  The report further finds that those receiving more services have poorer outcomes (Source: "Chronically Ill Patients Get More Care, Less Quality, Says Latest Dartmouth Atlas," The Robert Wood Johnson Foundation, April 7, 2008).

One example of variation found in the report is that Medicare spending on people in the last two years of life ranged from $59,379 in New Jersey to $32,523 in North Dakota.  Another example is that chronically ill patients in the last six months of life averaged 14.5 doctor visits in Ogden, Utah compared to 59.2 visits in Los Angeles. 

The report calculates the magnitude that all this variation creates for overall Medicare spending.  According to the report, total Medicare spending for the study population was $289 billion dollars between 2001 and 2005.  The authors estimate that this spending would have been $50.1 billion lower if everyone's spending mirrored spending in the area around the Mayo Clinic in Rochester, Minnesota.

This edition, "Tracking the Care of Patients with Severe Chronic Illness," was primarily funded by the Robert Wood Johnson Foundation.  According to Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation, "This report demonstrates the need to overhaul the ways in which we care for Americans with chronic illness.  The extent of variation in Medicare spending, and the evidence that more care does not result in better outcomes, should lead us to ask if some chronically ill Americans are getting more care than they or their families actually want or need."

The report includes several appendixes that list information for hospitals in different states, including Ohio.  Also, the Dartmouth Atlas Project has added a new Web feature with the release of this report, the Hospital Care Intensity Index. This feature allows comparisons on the intensity with which hospitals treat patients at the end of life—how many days they spend in the hospital and how often they see medical specialists.