Published: 2009-06-20 16:59:03
Author: Liz Kowalczyk | Boston Globe | May 17, 2009
Massachusetts General Hospital launched a pathbreaking effort to cut medical costs by reducing hospital stays and emergency room visits by the frail elderly - an initiative that underscores just how hard it will be for the medical industry to make good on its promise to President Obama to pare healthcare spending by $2 trillion over the next decade.
Under the Mass. General plan, the federal Medicare program would save millions of dollars, by reducing hospitalizations of several thousand elders by 15 percent to 20 percent while improving their care.
But to reap those savings the hospital has had to invest heavily up front, expanding the staffs of its primary care practices to provide time-consuming, hands-on help for patients struggling with a multitude of health problems, from fading memories to faltering eyesight.
The sheer intensity of the services, which most primary care doctors simply don't have the time to provide, points to daunting complexity of cutting costs while gaining better results for patients.
Dozens of efforts to improve the efficiency of treating this key patient group have failed. In a study of 35 programs published earlier this year, researchers found that six - including Mass. General's - improved patient care and at least covered their costs. The government extended those six projects until August 2012.
David Cutler, a healthcare economist at Harvard University, said that improving care for this group of very sick patients is crucial if the Obama administration and Congress are to afford an ambitious program to cover the uninsured. "If we can't do this, it doesn't bode well for health reform," he said.
Mass. General's program, which began in 2006, hinges on nurses in primary care practices being in almost constant contact with patients and helping arrange even nonmedical services.