Study: Medicare patients less likely to die in Minnesota hospitals

ST. PAUL

Medicare beneficiaries in Minnesota are less likely than those in other states to die in a hospital, because doctors and hospitals elsewhere pile on costly - and perhaps unwanted - care at the end of life.

That's part of the reason average Medicare spending per beneficiary in Minnesota is significantly below the national average.

But a new report suggests there are places in the state that follow the national trend - and not in a good way, according to researchers at Dartmouth College.

The St. Paul region, for example, saw a significant increase between 2003 and 2007 in the number of deaths that occurred at hospitals, the Dartmouth researchers say in a report being released today. The share grew from 23.8 percent in 2003 to 27 percent in 2007.

The St. Cloud area, meanwhile, had the largest absolute increase in the number of in-hospital deaths nationwide, with 33.8 percent of deaths among Medicare beneficiaries in the region occurring at a hospital during 2007. In 2003, that figure was 26 percent.

And among teaching hospitals, the University of Minnesota Medical Center, Fairview, had one of the largest increases in the average number of days patients spent in intensive care during the last six months of their lives.

"The University of Minnesota has relatively high use of inpatient care for these patients," said Dr. David Goodman, lead author of the Dartmouth report.

Summing up the broader issue, Goodman said in a statement: "In

addition to its effects on patients' quality of life, unnecessarily aggressive care carries a high financial cost."

Dartmouth researchers have focused on end-of-life care in several reports over the years; about one-fourth of all Medicare spending goes to pay for such care. By highlighting regions with above-average use of care at the end-of-life, the Dartmouth researchers hope to highlight others where spending can be reduced while quality of care improves.

In the most recent report, Minnesota performed better than the national average on three key measures of end-of-life care: the percentage of deaths occurring in hospitals; the average number of hospital days during each person's last six months of life; and the percentage of patients who saw 10 or more doctors during the last six months of life.

"Minnesota is below average on most of these measures, and this is a good thing," said Jan Hennings, spokeswoman for the Minnesota Hospital Association.

At the U, doctors wonder if the score might be explained by the fact that the medical center offers many advanced specialty services that attract patients seeking more intensive treatment, said Dr. Craig Weinert, an associate professor of medicine.

Another factor that could complicate the analysis, Weinert said, is that the Dartmouth study is focused on a subset of Medicare beneficiaries that happens to be relatively small in Minnesota. The Medicare patients who are excluded from the study are those enrolled in Medicare managed-care plans, Weinert said, and those health plans are known for working with doctors and hospitals to provide good end-of-life care.

Distributed by McClatchy-Tribune Information Services.

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