Report Cited by Obama on Hospitals Is Criticized By GARDINER HARRIS
February 17, 2010
For much of the past year, President Obama lavished praise on a few select hospitals like the Mayo Clinic for delivering high-quality care at low costs, but a pointed analysis published Wednesday in an influential medical journal suggests that the president’s praise may be unwarranted.
Mr. Obama received his information about the hospitals from a widely cited analysis called the Dartmouth Atlas of Health Care, produced by the Dartmouth Institute for Health Policy and Clinical Practice. ...........
But an analysis written in The New England Journal of Medicine by Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center in Manhattan, suggests that much of the Dartmouth Atlas is flawed and that it should not be used to compare the relative efficiency of hospitals.snip
The arguments are arcane, but were health overhaul legislation ever to pass, they could have profound effects on how medicine is delivered and paid for in the United States. Some proposals in Congress called for using analyses like those found in the Dartmouth Atlas to begin spending less money on regions where medical care is especially costly, including places like New York City.
Consumer Reports has adopted the information from the Dartmouth Atlas to help rate hospitals, a ranking in which Dartmouth-Hitchcock Medical Center fares well.
The Dartmouth Atlas uses payment information from the federal Medicare program, which provides health care to the elderly, to compare the amounts spent by hospitals on those who die in their care.
But Dr. Bach argues that the comparisons make no effort to determine if the hospitals are any better at saving people’s lives, and do little to adjust for the relative health of the patients being treated, among other problems.
The Dartmouth Atlas tends to rate poorly hospitals that provide lots of expensive procedures. But a different study published last week by researchers at the University of Pittsburgh found that patients tend to live longer in such intensive care hospitals.“We are about to embark on a huge transformation of our health care system,” Dr. Bach said. “If we start with a bunch of flawed measures, it will be as devastating as putting in the wrong coordinates before a moon shot.”
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http://www.nytimes.com/2010/02/18/health/policy/18dartmouth.html?hpw Weighing Medical Costs of End-of-Life Care by Reed Abelson
December 22, 2009
LOS ANGELES — The Ronald Reagan U.C.L.A. Medical Center, one of the nation’s most highly regarded academic hospitals, has earned a reputation as a place where doctors will go to virtually any length and expense to try to save a patient’s life.
Dr. Wenger said conflicts among family members “If you come into this hospital, we’re not going to let you die,” said Dr. David T. Feinberg, the hospital system’s chief executive.
Yet that ethos has made the medical center 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.
That distinction tends to get lost in the Dartmouth end-of-life analysis, which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive. Take the case of Salah Putrus, who at age 71 had a long history of heart failure.
After repeated visits to his local hospital near Burbank, Calif., Mr. Putrus was referred to U.C.L.A. this year to be evaluated for a heart transplant.
Some other medical centers might have considered Mr. Putrus too old for the surgery. But U.C.L.A.’s attitude was “let’s see what we can do for him,” said his physician there, Dr. Tamara Horwich.
Indeed, Mr. Putrus recalled, Dr. Horwich and her colleagues “did every test.” They changed his medicines to reduce the amount of water he was retaining. They even removed some teeth that could be a potential source of infection.
His condition improved so much that more than six months later, Mr. Putrus has remained out of the hospital and is no longer considered in active need of a transplant.
Because Dartmouth’s analysis focuses solely on patients who have died, a case like Mr. Putrus’s would not show up in its data. That is why critics say Dartmouth’s approach takes an overly pessimistic view of medicine: if you consider only the patients who die, there is really no way to know whether it makes sense to spend more on one case than another.snip
http://www.nytimes.com/2009/12/23/health/23ucla.html?_r=1&scp=1&sq=ucla%20darmouth%20hospital&st=cse California Hospital Study: Sometimes Spending More Actually Does Save LivesBy REED ABELSON
October 14, 2009
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the study is an outgrowth of widely cited research from the policy experts who produce the Dartmouth Atlas of Health Care, who have examined Medicare data and cited the tremendous variation in medical spending from city to city and region to region in this country – with little difference in the outcomes for patients. The Dartmouth researchers and others, including officials in the Obama administration, have long maintained that more care — like longer hospital stays and more examinations by specialists — is not always better care.
Because the additional cost of the extra care cited by Dartmouth accounts for hundreds of billions of dollars in potentially wasted spending in this country, lawmakers in Congress are keenly interested in reducing such spending to help keep the nation’s medical bills under better control.
But the new study in Circulation indicates that it is not always easy to determine which spending is wasteful. Researchers from the six California hospitals – five University of California medical centers, one private — decided to look at one category of patients, those with heart failure.
The Dartmouth data has tracked wide variations in spending among those same six hospitals to care for patients with chronic conditions, including heart failure, during the last six months of life. According to the Dartmouth thesis, higher spending does not translate to better outcomes for patients.
But the California researchers drew a different conclusion. “We see better survival rates at the hospitals that spend more,” said Dr. Michael K. Ong, the lead investigator for the study, who is a doctor at the UCLA medical center.
In some ways, the findings are a result of looking at the problem differently. Dartmouth researchers looked at hospitalized patients who had died, and then worked backward to trace the variations in spending on their care before their deaths. The California study examined all heart failure patients who had been hospitalized to see how they fared. The hospital with the highest cost for such patients had one-third fewer deaths than the one that spent the least.
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http://prescriptions.blogs.nytimes.com/2009/10/14/california-hospital-study-sometimes-spending-more-actually-does-save-lives/?scp=2&sq=ucla%20darmouth%20hospital&st=cse 
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