Why Are Medicare Bills So High at Los Angeles Hospitals – Answer May Lie in Access to Healthcare
Posted Sep 20 2009 10:20pm
It appears the costs are now under the microscope here, granted in the Los Angeles area we do have a great number of physicians and hospitals, just population would make relevance there. Now we have Cedars wanting to explore the matter too.
"Letting people die early is actually more cost effective," said Shah, who heads the cardiology unit at Cedars-Sinai Heart Institute. "But that's a perverted way of looking at things."
Are we practicing more expensive medicine here, probably I would guess, but when treatments are available, it would be a shame as the doctor stated above not to use them. If resources are available, doctors would take advantage and use them, and as a patient we want that too. Cedar also has a rich clientele of the rich who demand services too so that somehow has to enter the picture I would guess.
In another related story, one hospital in Downey, California is using their bankruptcy to get out from underneath their HMO contracts they state are accounting for their big dollar losses. The same day this hospital files bankruptcy, Kaiser opens a brand new state of the art facility down the road. The two types of hospitals and health plans can’t really be compared apples to apples as they are very different in proof of concept and actual operating processes. BD
Ampelio Garcia, 74, was barely able to walk when he got to White Memorial Medical Center in Boyle Heights, after the latest flare-up of a chronic lung condition that left him wheezing and gasping for air. Emergency room physician Brian Johnston prescribed drugs and a breathing treatment to open Garcia's airways. Then he admitted him -- for the second time in less than a week. "I can't send this guy home; there's no way," Johnston said. "And I don't think our treatment here is extreme or excessive. We're doing basic stuff."
"There's pretty good evidence that we simply overbuilt the acute-care sector, and we've done that more extensively in places like Los Angeles than we have elsewhere," said Dr. John Wennberg, founder of the Dartmouth atlas, which maps such variations. "Some places just have a lot more hospitals and a lot more doctors. They use them mostly for chronically ill patients, and it doesn't seem to have a beneficial impact on outcomes."
White Memorial serves some of the poorest people in the state. The median household income of its Boyle Heights neighborhood is $33,000, a little more than half the statewide figure. Almost nine out of 10 of its patients lack private health insurance. Many don't have a regular doctor, hospital officials say. And even when they do, they have trouble getting to them.
Take Catholic Healthcare West, which operates hospitals in both cities, for example. In Sacramento, Medicare's costs for CHW patients in the last two years of life averaged $49,157. In Los Angeles, the figure was almost twice that.
They found that the hospital with the most aggressive and expensive practices had the lowest death rate -- more surviving patients -- six months after initial admission. The inverse also was true: The hospital where physicians did the least had the highest death rate. Next, the Cedars-UC researchers want to study what courses of treatment produce the best results, to improve the way physicians handle the costliest patients. "We want to know why patients seem to do better at one hospital versus another, and we want to know whether there is a causal relationship between resource use and mortality," Cedars' Langberg said. "We don't know that yet."