Wall Street Journal Examines Physician’s Recommendations To Reduce Health Costs

The Wall Street Journal on March 21 profiles Dr. John Wennberg, a Dartmouth College physician who has conducted a number of studies over the past 30 years on the practice of medicine in the United States. Wennberg's research has found "little scientific basis for the differences in the way medicine is practiced" across the nation and "little evidence that giving more care always extends lives." In addition, he has said that the United States "could save a lot of money if we figured out what care is valuable and what is not -- and provided more of the first and less of the second." For example, Wennberg has found:

• The average 65-year-old in Miami will cost Medicare $50,000 more over a lifetime than the average 65-year-old in Minneapolis.
• Three out of 1,000 Medicare beneficiaries undergo heart bypass surgery each year in Albuquerque, N.M., compared with 11 per 1,000 in Redding, Calif.
• Only 14% of terminally ill patients in Sun City, Ariz., enter an intensive care unit in the last six months of life, compared with 49% in Sun City, Calif.
• Elderly men in Binghamton, N.Y., have their prostates removed nine times more often than elderly men in Baton Rouge, La.

'Limited Impact'
Although Wennberg's research has allowed doctors, hospitals and patients in a number of communities to compare performance, it has not "significantly changed" the U.S. health care system, the Journal reports. "He's been slogging away at this for 30 years, mostly in the wilderness in terms of the general public," John Iglehart, editor of Health Affairs, said. According to Wennberg, "Changing the health care system is like changing the Catholic Church. It takes a long time." The Journal reports that the "limited impact" of Wennberg's research is due in part to "some shortcomings." His research focuses on "easy-to-measure outcomes" but does not yet determine whether the "quality of patients' lives is better in places" where, for example, doctors perform bypass surgery more often. In addition, although Wennberg has identified communities where doctors may perform "unnecessary procedures," he cannot determine "which patients should undergo surgery and which should not." However, the Journal reports that Wennberg's research does highlight "ignorance" in the U.S. health care system. For example, Wennberg has found "huge variation in success rates" for treatment of a number of diseases, but doctors and hospitals make "unconscionably little effort" to determine the cause. Wennberg also has said that the U.S. health care system's focus on cost rather than quality has failed to reduced health care costs in the long-term. For example, traditional fee-for-service Medicare reimburses doctors and hospitals "whether care was appropriate or not, whether the doctor was high or low quality." Based on his research, Wennberg suggests that "it's time for government, insurers and employers to move toward paying doctors and hospitals based on the quality of the care they provide, not the quantity" (Wessel, Wall Street Journal, 3/21). More information on Wennberg's research is available online.