Higher Spending CA Hospitals Demonstrate Lower Mortality Rates

Cheryl Clark, for HealthLeaders Media , February 1, 2011

Another part of the study found that hospitals with lower mortality and intensive spending may not have high adherence standard process measures, such as giving an aspirin at admission for patients who arrive with a heart attack. "Reported process measures may simply do a poor job of explaining variation in hospital mortality," the authors wrote.

The report goes against findings in the Dartmouth Atlas that spearheaded much of what is being looked at in healthcare reform regulations, that expensive care is not necessarily better care, and may in fact be worse care.

"A convincing set of studies (Dartmouth Atlas) demonstrates that U.S. regions that spend more on medical care have similar or poorer patient outcomes than areas that spend less on medical care," Romley and colleagues write. That study found that "regions vary widely in both spending and quality of care, with high-spending regions using more specialists, diagnostic tests and imaging, and inpatient hospital care, yet generally producing no better care."

The report has several limitations. For starters, it excluded patients with cancer, which is known for its high cost of care.

It also does not identify the specific types of high-cost interventions that high-spending hospitals undertake to achieve lower mortality.

However, the authors wrote, there is some suggestion from prior studies patients whose conditions give them have a high or moderate risk of death are less likely to die in hospitals that put more of their patients in intensive care units, provide mechanical ventilation or administer dialysis.

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