Iowa Hospitals No. 1 with High-Value Care

A new study shows Iowa hospitals are best in the nation for controlling costs without diminishing care.  In the study by Dartmouth College, Medicare spent an average of $39,243 per chronically ill patient for end-of-life care in Iowa, the lowest in the nation and more than 30 percent below the national average of $52,838.  Meanwhile, New Jersey, the highest-cost state, spent $66,770 per patient – 70 percent more than Iowa (see table below).  Medicare spending at individual hospitals was also calculated in the study, and all Iowa hospitals fell significantly below the national average.

In higher cost states, which consumed more than one and half times the Medicare dollars spent by the lowest spending states, patients did not live out their final years healthier than those in low-cost states like Iowa, meaning Medicare wasted billions of dollars.  In effect, taxpayers in Iowa and other low-cost states are subsidizing the excessive care seen in much of the nation.

IHA has pressed Congress and the Centers for Medicare & Medicaid Services to initiate policies that provide for value-based purchasing.  Such policies would go a long way in addressing the variations seen in the Dartmouth study.

Authors of the study also blamed current Medicare payment policies for causing wide variations in care and wasting resources.  “Probably the most important driver of how health care resources are established and used is the current reimbursement system,” the authors wrote.  “Hospitals and doctors are paid for activities – hospitalizations, procedures, tests – and are economically punished for using less-invasive, less-costly strategies of care.

“Finding that waste and eliminating it would help provide financial security for the Medicare program without loss of value to the people it covers.”

Along with Medicare spending, the Dartmouth study, provided through the college’s extensive Dartmouth Atlas of Health Care, compared other measures of effective utilization that also pointed to Iowa as a leader.  For example, Iowa patients in the study spent fewer than three days in intensive care, while the national average was six days.  The study also showed Iowa patients spent far fewer days in the hospital (16 days versus 24 days nationally), saw fewer physicians, were less likely to die in the hospital and more likely to use hospice services.

Overall, the Dartmouth researchers concluded, lower-spending states like Iowa tend to have:

Better adherence to process-based measures of quality.

Fewer hospital stays, physician visits, specialist referrals, imaging orders and minor tests and procedures.

- Better communication among physicians.
- Better continuity of care.
- Better access to care and shorter waiting times.

More information, including the complete study and a searchable database of state, regional and hospital-specific data, is available at www.dartmouthatlas.org.