Refuting Five Healthcare Myths about quality of care, a new study by researchers at Dartmouth Medical School shows that spending more on chronically ill elderly patients does not necessarily improve outcomes. Published in the new edition of the Dartmouth Atlas of Health Care, the findings demonstrate the need to assess efficient clinical practices to ensure that healthcare spending produces high-quality health care with better outcomes for patients.

The aging baby boomer population combined with rising healthcare costs is a growing strain on our healthcare system, said John E. Wennberg, MD, the study’s principal investigator and director of Dartmouth’s Center for the Evaluative Clinical Sciences. As a result, it is critical that patients do not receive unnecessary care. The Dartmouth Atlas Project study shows that it is possible in health care to achieve equal and often better outcomes using fewer resources by adopting best practices.

Five common beliefs about healthcare spending and the reasons to reassess our current system are described below.

Myth #1: The Medicare program is running out of money, and soon care will have to be rationed for the program to remain solvent past 2020.

Fact: There is enough money in the system to provide all the services that Medicare enrollees need and want and that actually work. Paying only for services that are demonstrated to be effective and that meet high-quality standards would save the Medicare program an estimated tens of billions of dollars. That money could be reallocated Refuting Five Common Healthcare Myths to provide needed, wanted, useful services to everyone for the foreseeable future.

Myth #2: The more tests, hospitalizations, doctor visits, and specialist consultations a patient obtains, the better the outcome, health, and quality of care a patient is receiving.

Fact: Both physicians and patients generally believe that more services—that is, using every available resource—produces better outcomes. Based on this assumption, the supply of resources, not the incidence of illness, drives use of the services. However, more of these services often result in the opposite—shorter life expectancy and lower quality of life in the final months and years of life. For people with the most common chronic illnesses, such as cancer, congestive heart failure, and diabetes, more aggressive treatment at end of life neither prolongs nor improves quality of life. In addition to the tremendous waste of resources for the patient’s welfare and comfort, paying for futile care strains Medicare resources and reduces the ability to fund more productive activities, such as providing coverage to the approximately 46 million uninsured.

Myth #3: As baby boomers age, they will create greater demands on the healthcare system. Therefore, the country has an urgent need to expand the supply of physicians.

Fact: The current physician supply is more than adequate, if the workforce were organized into efficient practice models such as those of such exemplary providers as Intermountain Healthcare, Kaiser-Permanente, the Mayo Clinic, and Group Health Puget Sound. If the entire country could safely adopt the practice patterns of the lowest cost regions, U.S. spending for hospital and physician care would fall by 30 percent.

Myth #4: America’s academic medical centers are assumed to be the best-of-the-best in terms of quality of care and efficiency.

Fact: There is a huge variation among academic medical centers in practice patterns, quality, and efficiency, partially because there is no agreed upon gold standard for the majority of medical practice. Most practice is theory-based rather than evidence-based.

Myth #5: Acute care hospitals are the best place to treat people with severe chronic illnesses, such as cancer, diabetes, and congestive heart failure.

Fact: Acute care hospitals are often not appropriate sites to manage severe chronic illnesses. Acute care hospitals are excellent at treating immediate life-threatening conditions (such as head trauma and heart attacks) for which hospital-based medical care is the best strategy. However, acute care hospitals in many areas of the country have become increasingly engaged in treating people with chronic medical conditions, an expensive, inefficient, and ineffective care management approach.

We need a new model to care for severe chronic illness that is not hospital- based, improves the quality of patients’ lives, reduces spending, and frees resources to provide more effective care for everyone. Currently, discrepancies in how hospitals care for chronically ill Medicare patients add at least $10 billion to the cost of Medicare every year, one-third higher than necessary without getting better results.

The Dartmouth report clearly addresses the need to overhaul the way chronic illness is managed and invest in an infrastructure that can better coordinate and integrate care outside of hospitals, such as home health and hospice care. The report also calls for a payment system that rewards, rather than penalizes, provider organizations that successfully reduce “over care” and develop broader strategies for managing their patients with chronic illness.

The Dartmouth Atlas Project research study is based on Medicare claims data for more than 4,300 hospitals in 306 regions. The findings and a new database are available at www.dartmouthatlas.org. The study was funded by the Robert Wood Johnson Foundation.