Study calls for overhaul of healthcare system.

Treatment costs for the elderly and chronically ill, especially those at the end of life, could be greatly reduced by adopting a model that focuses more on palliative care in non-hospital settings, according to a recently released study from the Center for the Evaluative Clinical Sciences (CECS) at Dartmouth Medical School. The study purports that the healthcare industry lacks evidence-based standards of care for those with severe conditions which require medical management but which cannot be cured. It contends that lack of standards leads to overuse of acute hospital-based treatment, which leads to overspending and to ineffective levels of treatment and care. As proof, researchers point to wide variations in lengths of stay for patients hospitalized during the last six months of life.

For example, average length of stay was 12.9 hospital days at St. Mary's Hospital (of the Mayo Clinic) versus 23.9 days at New York-Presbyterian Hospital. Similarly, ICU days was highest (11.4 days) at the University of California (UC) at Los Angeles teaching hospital, compared to 3.3 days per decedent at the UC teaching hospital in San Francisco. Moreover, the report asserts that a $123 billion Medicare bill could have been reduced by $40 billion, over a four-year period, if all regions of the country had treated cost-effectively, and points to Intermountain Healthcare in the Salt Lake City region as exemplary. The study essentially calls for an overhaul of the current healthcare system so that it financially rewards provider organizations that reduce excessive use of services while developing quality-conscious strategies of care for the chronically ill. Logon to www.dartmouthatlas.org to find "The Care of Patients with Severe Chronic Illness: An Online Report on the Medicare Program" by the Dartmouth Atlas Project.