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Controlling Health Costs: Provide Care More Like Duke Hospital

With all the talk about controlling health care costs, I thought it would be good to take yet another look this afternoon at the huge regional variation in how much we spend on health care and how aggressive we are in treating patients. (Data and reports are from the Dartmouth Health Atlas [1]).

Compare [2]our own Duke University Medical Center with another excellent hospital, Cedars-Sinai Medical Center in Los Angeles. Look at spending on similar Medicare patients in the last two years of life and you find some major surprises:

1. Duke spends roughly half per Medicare patient than does Cedars-Sinai ($57,411 at Duke v. $106,951 at C-S).

2. A patient at Duke will spend about half the time in the hospital than if they were at Cedars-Sinai (13.75 days v. 24.41 days at C-S).

3. A patient at Duke will have only 1/3rd of the physician visits at patient at Cedars-Sinai will experience (24.14 visits v. 79.34 visits at C-S).

The difference is not due to any variation in the illness, the preferences of patients, or science being different in LA v. Durham. All patients are insured through Medicare, all are all living through the last two years of their lives, and all are being treated at one of the top medical centers in the country. All patients have similar health outcomes and are similarly satisfied with their care.

As the Dartmouth researchers have repeatedly demonstrated, this enormous variation in the cost and aggressiveness of treatment is due to physician preferences between the two hospitals.

Put simply, Duke in Durham is delivering world-class care at roughly half the cost of some of the other top medical centers in the US. Not that Duke doesn’t have room for improvement. Some other centers deliver great care at even lower cost, but even so, if we could simply provide care in the same way across the country that Duke provides care here in Durham we would begin to address of health care cost problem.