Battle Lines Drawn: Quality vs. Cost


The cost of healthcare varies widely from hospital to hospital and doesn't appear to be inherently linked to the quality of patient care, according to a study in the Archives of Internal Medicine.

"It's particularly perplexing because the differences in cost are quite substantial," says Mitchell Katz, MD, director of San Francisco's public-health program and the author of an accompanying editorial calling for more research.

The Feb. 22 report found wide disparities in the costs of care but no strong correlation in the context of patient care or the risk of death within 30 days. The nationwide study by researchers at the University of Michigan reviewed some 3,150 hospitals that discharged Medicare patients admitted for congestive heart failure or pneumonia in 2006. Data were studied in association with variables including readmission rates and quality scores.

Compared with hospitals in the lowest-cost quartile for congestive heart failure care, the researchers found that hospitals in the highest-cost quartile had higher quality-of-care scores (89.9% vs. 85.5%) and lower mortality for congestive heart failure (9.8% vs. 10.8%). For pneumonia, however, the converse was true. Compared with lower-cost hospitals, high-cost hospitals had lower quality-of-care scores (85.7% vs. 86.6%) and higher mortality (11.7% vs. 10.9%).

Dr. Katz is heartened that the study found longer length-of-stay (LOS) at high-cost hospitals, suggesting that decreased LOS—a staple of HM's value-added services—will slash hospital costs. But he says more randomized, comparative-effectiveness studies need to be published. Hospitalists are in a natural position to author those examinations, he says. "One of the roles of a hospitalist can be to be advocates of 'Yes, we think it can be done,' " Dr. Katz says. "Because there are a lot of doctors who want to say, ‘No, it can’t be done.' "

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