According to researchers at Dartmouth Medical School, Salt Lake City, led by Intermountain Health Care, provides superior care to chronically ill patients while limiting the number of doctor visits, hospital stays and admissions to intensive care units. And if all hospitals and doctors adhered to the standards set by Intermountain, Medicare could have saved $40 billion - almost one-third of what it spent - from 2000 to 2003.
"That's the big 'wow' of this," said Brent James, Intermountain's vice president for medical research and executive director of its Institute for Health Care Delivery Research. "We can debate how long until Medicare bottoms out, but it's in a free-fall and many of us think it can't survive unless something profound changes."
As national experts praise Intermountain as a model for the rest of the country, a legislative task force is debating whether the system is good for Utah. Specifically, legislators are looking at whether the health care conglomerate restricts competition to the detriment of consumers.
An independent economist weighed in last week, saying Intermountain's integrated system has created vigorous and cost-conscious rivalries. Now comes the Dartmouth study, which insists the Intermountain way is the right way, at least when it comes to caring for the chronically ill.
More than 75 percent of all U.S. health care expenditures are related to chronic-disease management, and nearly 30 percent to 35 percent of all Medicare dollars are spent on patients in the last two years of their lives, most of whom are suffering from at least one chronic illness.
That's why researchers for the Dartmouth Atlas Project compared the care at 4,300 hospitals by examining the medical records of 4.7 million Medicare patients in the last two years of their lives who had at least one chronic condition. Two-thirds of the patients were diagnosed with cancer, congestive heart failure and/or chronic lung disease.
The study, funded by the Robert Wood Johnson Foundation, found hospitalization rates weren't related to the type of disease or demographic factors such as race so much as where the patients lived. And, on average, a patient in Salt Lake City spent less time in the hospital, less time in intensive care units, less time at the doctor's office and less time with specialists, and still received high-quality care. Researchers found similar results in Portland, Ore., and Rochester, Minn., home to the Mayo Clinic.
In doing so, they debunked a basic assumption held by most doctors and patients - that more care constitutes better care and therefore all available resources should be used to manage difficult illnesses, driving up costs.
"It can no longer be assumed that people with severe chronic illness who live in communities with more intensive use of hospitals have improved survival, better quality of life or better access to care," the study concluded. "What is clear is that people with severe chronic illnesses have a greater chance of dying in an ICU than anywhere else."
Patients who spent considerable time in the hospital or intensive care actually had higher mortality rates because, as James says, hospitals are dangerous places. "As soon as you're in the hospital you're at risk for all the bad things that can happen in hospital, such as picking up infections and getting the wrong medication," he says.
Not only is Intermountain recognized for reducing those kinds of errors, but the provider's overall approach to health care is based on collecting data on what works and what doesn't; educating patients on the consequences of diet, medication, weight management and blood-pressure control; and the coordination of care among doctors, nurses and specialists. And while James says there is always room for improvement, Salt Lake City has set the standard.
"Health care organizations serving these low-cost regions aren't withholding needed care," said co-author Elliott Fisher, professor of community and family medicine at Dartmouth Medical School, in a statement. "On the contrary, they are more efficient. They achieve equal and often better outcomes with fewer resources.
"These organizations offer a benchmark of performance toward which other systems should strive."
lfantin@sltrib.com
