Letter to Colleagues in the Senate

Letter

Klobuchar: Report of Geographic Disparities in Medicare Shows Need For Major Overhaul

Tens of billions of dollars could be saved using Mayo Clinic's Model

In a letter to her colleagues, U.S. Senator Amy Klobuchar called for any major overhaul of Medicare to take into account research from the Dartmouth Institute for Health Policy and Clinical Practice showing dramatic differences in Medicare spending throughout the country. The Dartmouth report supports Senator Klobuchar's previous calls to fix the Medicare system by incorporating many of the cost-efficient effective measures employed by the Mayo Clinic in Rochester, Minnesota.

"As we struggle to find ways to keep Medicare solvent, we must acknowledge the impact of geographic disparity on health care (as this report shows) and the resulting effect that such disparity has on our budget," said Klobuchar. "A high-quality, low-cost state like Minnesota gets shortchanged, especially in our smaller communities and rural areas."

The letter, also signed by Senator Judd Gregg (R-NH), highlights the latest edition of the Dartmouth Atlas of Health Care, "Tracking the Care of Patients with Severe Chronic Disease," which was published by the Dartmouth Institute For Health Policy and Clinical Practice.

The report presents data showing significant geographic variations in the quality of supply-sensitive care provided to Medicare recipients suffering from chronic diseases during the last two years of their lives. According to the data, the disparities in funding and quality did not stem from the prevalence of certain serious illnesses in different areas of the country. In addition, more care does not necessarily correlate to better care and better health outcomes.

Over 75 percent of all health care spending goes towards caring for people with chronic disease. The Atlas report shows that many hospitals over-use and overspend precious resources, causing costs to skyrocket. The average senior in Miami costs Medicare about twice as much per year as a senior in Minnesota. Yet, Medicare's own reports show that the quality of care is significantly higher in Minnesota. (Demographic and cost-of-living differences account for only a portion of the geographic disparity.)

Full text of the letter below:

Dear Colleague:

We write to bring the latest edition of the Dartmouth Atlas of Health Care to your attention. "Tracking the Care of Patients with Severe Chronic Disease," authored by Dr. Jack Wennberg and his colleagues at the Dartmouth Institute for Health Policy and Clinical Practice, provides information worthy of consideration as we prepare to reform our health care system.

The data compiled in this latest edition of the Atlas shows significant geographic variations in the quality of supply-sensitive care provided to Medicare recipients suffering from chronic diseases during the last two years of their lives. While one might assume this variation to be caused by the prevalence of certain serious illnesses in different areas of the country, the authors have concluded that these disparities are actually caused by the geographic areas where the patients live, as well as the hospitals and health care systems they choose. The study finds that the assumption that those living in the regions getting more care receive better care and achieve better health outcomes does not hold true

As we struggle to find ways to keep Medicare solvent, we must acknowledge the impact of geographic disparity on health care, and the resulting effect that such disparity has on our budget. Analyses of variations in practice and spending provide useful insights into the underlying drivers of health care quality and costs.

The eye-opening findings outlined in this year's Dartmouth Atlas of Health Care confirm that incentives for quality care, coordinated treatment, and patient-doctor communication all need to be part of our upcoming debate on health care.

We hope that you and your staff find this report, which may be found on-line at www.dartmouthatlas.org/atlases/2008_Chronic_Care_Atlas.pdf, helpful as we prepare for next year's discussion.

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