'Unwarranted Variation' in Use of Medicare Services

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<p>Many initiatives for improving the quality of health care focus on the underuse of therapies proven to be effective in clinical studies. But while giving providers incentives to "do the right thing" will likely save lives, it is unlikely to have a major impact on rising costs, a new <a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=19872&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D326732%26%23doc326732">Commonwealth Fund report</a> finds.<br><br>Only a relatively small proportion of health care dollars is influenced by effective care, particularly in chronic illness, says the report's author, John E. Wennberg, M.D., director of the Center for the Evaluative Clinical Sciences at Dartmouth Medical School. In studying the treatment provided to severely ill Medicare patients at 77 highly regarded hospitals, Wennberg and colleagues with the Dartmouth Atlas Project found that most spending falls into two other categories of care that relate to either misuse or overuse. These are "preference-sensitive" care, which often is based on a failure to obtain a patient's fully informed opinion about alternative treatments available, and "supply-sensitive" care, the volume of which is largely determined by the local supply of resources.<br><br>The analysis, based on data from patients in their last six months of life (to control for severity of illness), found that the hospitals studied differed sharply in the way they managed their patients. This often was true even among hospitals in the same state or city.<BR><bR>Wennberg says the availability of information on the relative efficiency of specific health care organizations in managing chronic illness could stimulate payers to reexamine their provider networks and motivate employers to steer their employees toward efficient hospitals.</p>