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Find End-of-Life Care to Fit Your Finances

Lola Butcher, Bankrate.com

The question of cost drives many aspects of life; it even can play a role in choosing a hospital for end-of-life care.

Want to fight the grim reaper with every weapon at your disposal, and no expense spared? In Miami, Westchester General Hospital is the place for you. New Yorkers should head to NYU Langone Medical Center, and in Savannah, Ga., patients will want Candler Hospital.


But if you prefer to spend fewer hours in a doctor's waiting room, fewer days in the hospital intensive care unit and less money on insurance co-payments, other hospitals would work better for you.

The average patient served by suburban Miami's Memorial Regional Hospital spends about $4,300 on physician co-payments in the last two years of life, compared to more than $6,600 for patients treated at Westchester General. The cost is less at Memorial Regional because end-of-life patients are treated less intensely. They have fewer days in intensive care and more in hospice care, fewer specialist appointments and more days at home, than at Westchester General.

End-of-life treatment is dramatically different in New York than in Savannah and just about every other community in America.

How can that be? Even Dr. Elliott Fisher, a Dartmouth Medical School professor who has been researching the geographic variation in health care for more than 20 years, is often surprised by how much patient care varies from one hospital to the next. Fisher, principal investigator for the Dartmouth Atlas project, is director of the Center for Health Policy Research at the Dartmouth Institute for Health Care Policy and Clinical Practice.

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"You will be treated aggressively if you are in some hospitals and more conservatively if you go to others," he says.

Now there's a way for patients to find out the services that hospitals offer. They can check out their own local hospitals through a new, free online tool, the Hospital Care Intensity Report, or HCI. It shows the end-of-life treatment patterns for Medicare patients at every hospital in the country. You can read more about how to get the most out of this information in the Bankrate feature "Which hospital is right for you?"

The HCI is based on information from the Dartmouth Atlas of Health Care, which has been documenting this variation for nearly three decades.

Research by the Atlas team has revealed that physicians are influenced by many factors, ranging from the number of MRI scanners and the number of hospital beds in the community to the practice methods of their local colleagues.

So the process of diagnosing and treating a patient in one location can turn out to be completely different from another location, without either physician clearly being "wrong" in his or her approach.

The Dartmouth researchers have uncovered another fact that is equally surprising: More health care does not mean better health.

"Higher intensity care does not mean that you will live longer," Fisher says.

In fact, research shows that more intensive care -- meaning more days in the hospital, more physicians involved in decision-making, more medicines and more procedures -- adds up to slightly worse outcomes for patients on average.

His favorite example is the Mayo Clinic. The famous academic medical center in Rochester, Minn., has documented proof that it provides patient care that is simultaneously high-quality and low-intensity.

While consumers may have a choice between high- and low-intensity care, they should not be passive patients when their physician enters the room, the HCI report says.

"The remarkable variation across hospitals underscores the importance of consumers understanding what kind of care they want," Fisher says. "It's important to think about where you go (for hospital care) and also to engage with your providers wherever you go to make sure your preferences are clear."

The hospital report and the Atlas are based on Medicare-claims data that constitute the richest source of information about health care available, including the kind of care patients receive at the end of their lives.

Consumers of any age can use the Atlas as a guide to compare treatment patterns at various hospitals. "The way patients are treated at end-of-life is correlated with how they are treated at other stages of life," Fisher says.