Related KHN Article:<\/h3>\n
\n Reaction To Cooper’s Challenge Against Dartmouth Atlas<\/a> <\/p>\n<\/p><\/div>\n \n “The Crisis of Physicians Supply and the Myths of Health Care Reform<\/a>” (.pdf)<\/p>\n<\/p><\/div>\n The argument has been embraced by President Barack Obama’s administration and several lawmakers, who have repeatedly said that the nation could save as much as $700 billion a year — if only doctors and hospitals in high-spending areas, such as Philadelphia, Los Angeles and Chicago, would end their profligate practices and adopt the thriftier ways of say, the Geisinger Health Systems, based in Danville, Pa. The House has inserted provisions in the health bill that could punish high-spending hospitals in Philadelphia and elsewhere, while rewarding low-spending facilities in places such as Albuquerque, N.M., Madison, Wis., or Portland, Ore. <\/p>\n \n The Poverty Factor <\/strong>\n <\/p>\n But Cooper and some allies say that would be a disaster and hurt efforts by doctors and hospitals to care for the poor. Cooper says the Dartmouth research doesn’t take into account the high cost of helping the impoverished, who often spend more time in hospitals because they don’t have people to care for them at home and often return to the hospital when they can’t afford needed medications. <\/p>\n \u201cThere is abundant evidence that poverty is strongly associated with poor health status, greater per capita spending, more hospital readmissions and poorer outcomes,\u201d he wrote in an Oct. 24 post <\/a>on his blog. \u201cIt is the single strongest factor in variations in health care and the single greatest contributor to ‘excess’ spending.\u201d <\/p>\n \u201cDon’t say our failure is that medicine is bad in Mississippi and the South Bronx,\u201d Cooper adds in an interview. \u201cThat’s a social problem. We’re bad because we don’t spend enough in areas of poverty.\u201d <\/p>\n Cooper is emerging as the most provocative voice among a small group of health care experts raising doubts about Dartmouth’s methods, which focus on comparing how hospitals treat Medicare patients in their final two years of life. It is from those studies that Dartmouth came to its most far-reaching conclusion: that too much medical care can actually hurt patients rather than help them. But the skeptics say the way hospitals treat Medicare patients can’t be translated into firm conclusions about the country’s overall health spending and trends.<\/p>\n Dartmouth researchers say that Cooper is flat-out wrong. They say that even when you take the socio-economic levels of patients and sicker populations into account, some hospitals spend far more than others without good reason. And they say their studies show Medicare spending is a good indication of how hospitals generally operate.<\/p>\n \u201cIt’s impossible to carry on a debate with somebody who does not understand statistics, and seems uninterested in learning,\u201d Jonathan Skinner, a senior author of the Atlas, says of Cooper. <\/p>\n Other critics of Cooper \u2014 and there are many \u2014 say he has not offered a better way to analyze spending variations among hospitals, but instead takes potshots. They say he tends to embrace data that back up his long-held view that the country needs more doctors, and is too eager to flout professional customs. In December, he was banned<\/a> from writing for the journal Health Affairs for five years for breaking a rule against sharing articles before publication. <\/p>\n \n Hospitals Defend Spending <\/strong>\n <\/p>\n The counterattacks haven’t slowed Cooper down. These days, he’s working with several Democratic members of Congress, including Rep. Allyson Schwartz, D-Pa, whose district includes parts of Philadelphia, and Rep. Shelley Berkley, D-Nev. Cooper’s criticisms are also being cited by the lobbyists for the nation’s teaching hospitals and some state hospital associations, including New York’s. All are trying to ensure the health overhaul bills don’t lead the government to unfairly penalize high-spending parts of the country. <\/p>\n \u201cOur institutions are barely getting by,\u201d says Atul Grover, chief advocacy officer at the Association of American Medical Colleges. \u201cThey’re struggling to take care of people who can’t get care anywhere else, and now they’re talking about cutting them, saying they’re inefficient.\u201d <\/p>\n Hospitals in the greater Philadelphia area certainly have reason to worry. Overall, the region’s hospitals billed Medicare $66,974 on average for patients in the last two years of life, according to the most recent Dartmouth data, covering the years 2001 through 2005. That was 25 percent above the state average of $53,373, and 27 percent above the national average of $52,838. <\/p>\n The highest-spending hospitals –\u00a0such as Temple University Hospital, which Dartmouth says spent $85,538 on the average Medicare patient for the period\u00a0– say they provide more treatment because their patients are poor and enter Medicare with greater health problems. A Temple spokeswoman says they treat more Medicaid patients than any other hospital in the state. Teaching hospitals in the city note that under Medicare rules they get paid extra.<\/p>\n \u201cOur costs are higher because we have more technology, we have a wider range of programs,\u201d says Ralph Muller, chief executive officer of the University of Pennsylvania Health System, which spent $80,727 on Medicare patients in their final two years of life. \u201cWhen you adjust for a teaching hospital, a lot of the variation goes away.\u201d <\/p>\n Dartmouth researchers counter that they have compared hospitals with similar patients’ populations and still found wide differences in spending. <\/p>\n \u201cThere are a lot of people and a lot of hospitals, particularly in big cities, that feel threatened by the message of the Dartmouth Atlas,\u201d says Skinner. \u201cFor them to find a spokesperson who is absolving them of all sin is very appealing to them.\u201d <\/p>\n So who’s right? To help find an answer, the House health overhaul legislation would direct the prestigious Institute of Medicine to research the causes of geographic variations. The institute then would recommend how Medicare can best identify and clamp down on regions where the spending is unjustifiably high. In a partial victory for Cooper and his allies, the bill requires that the institute take into account \u201csocio-economic factors\u201d as well as the health status of patients. <\/p>\n Other researchers’ work is raising questions about Dartmouth’s conclusions. A recent study<\/a> published in Circulation, the journal of the American Heart Association, followed patients at six California teaching hospitals who had been hospitalized for heart failure. The study found that those who received more treatment from the hospital — through procedures, tests or days as a patient — were more likely to survive than those who got less medical care. <\/p>\nRelated Links<\/h3>\n
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\n Health Affairs <\/em>letter banning Cooper from the journal for 5 years<\/a> <\/li>\nInteractive Dartmouth Graphic: Regional Differences In Medicare Spending<\/h3>\n
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Cooper’s Presentation<\/h3>\n