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Hospitals that spend more on emergency care see better outcomes, MIT says

The low-cost hospitals with good outcomes are the ones that spend more when the patient is there, and less when they leave.

Jeff Lagasse, Associate Editor

Hospitals that spend more on initial care following patient emergencies see better outcomes than those that spend less at first and rely more on other forms of long-term care, according to a new study from researchers at MIT.

Specifically, hospitals that invest more in inpatient care get better results per dollar spent, as opposed to those that assign a higher percentage of patients to skilled nursing facilities when they're discharged. The focus on inpatient treatment was linked to lower mortality rates among elderly Medicare patients -- in fact, such patients are substantially less likely to survive over the following year.

Ultimately, the low-cost hospitals with good outcomes are the ones that spend more when the patient is there, and less when they leave, according to the study.

What spurred the study was data showing the United States spends 40 percent more on healthcare per capita than the next highest-spending country on the list, suggesting grave inefficiencies in U.S. health spending.

[Also: Medicaid expansion results in more emergency room trips; fewer patients uninsured]

To conduct the experiment, researchers honed in on ambulance company practices that essentially provided a randomized group of patients to study. By and large, multiple ambulance companies cover a given area, and their assignment to patients is more or less random; but those companies often have agreements concerning which hospitals they deliver patients to, circumventing one problem in comparing hospital outcomes: That one hospital's patients may typically be less healthy than another's.

The average 90-day spending on patients in the study is about $27,500, and for every additional spending increase of about $8,500, there was a 2 percent reduction in mortality risk. There was, however, a 5 percent increase in mortality at hospitals that spend a lot on "downstream" nursing facilities.

The research also suggests that bundled payments made to providers might be better apportioned according to the effectiveness of the type of care provided -- meaning it may be worthwhile to reimburse providers more for the more effective portion of their healthcare.

Twitter: @JELagasse

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