The Dartmouth Atlas of Health Care examined Medicare payment data in the last two years of life and found that Medicare spending varied significantly by region and determined that hospitals that spent the most on care were not necessarily delivering the best care.
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 also adopted the information from the Dartmouth Atlas to help rate hospitals.
In an article in the February 17, 2010 edition of the New England Journal of Medicine, Dr. Peter Bach challenges the methodology used in the Atlas. Bach sites the biggest flaw in the Dartmouth Study as the assumption that hospitals are accountable for all patient care provided in the last two years of life. He says that the study presumes that the hospital where a patient was most frequently admitted before death should influence follow-up care.
Another problem cited is that The Dartmouth Atlas uses payment information from the federal Medicare program to compare the amounts spent by hospitals on those who die in their care. 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.
(SOURCES: New England Journal of Medicine, http://nejm.org, February 17th, 2010, Advisory Board Daily Briefing, http://advisory.com, February 18, 2010; The New York Times, http://nytimes.com, February 17, 20010)