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Cardiovascular Perspectives

The Cost of End-of-Life Care

A New Efficiency Measure Falls Short of AHA/ACC Standards

Gerald W. Neuberg, MD, FACC

From the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.

Correspondence to Gerald W. Neuberg, MD, Allen Pavilion 2-246, 5141 Broadway, New York, NY 10034. E-mail gwn1@columbia.edu

Received October 24, 2008; accepted December 18, 2008.

Key Words: appropriateness criteria • cost analysis • efficiency measures • end-of-life care • hospital costs • risk-adjustment

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Skyrocketing costs jeopardize health coverage at every level and impede efforts to cover the uninsured.^1,2 Observations that higher cost care is unassociated with improved outcomes^3,4 have further stimulated efforts to gain more value for our healthcare dollars.^5,6 To identify and deter unnecessary care (estimated to account for 30% of all health costs),⁴ new provider performance measures and incentives are being developed,^7,8 but we must understand their strengths and weaknesses to ensure that they do not misrepresent or compromise care.

Care near the end of life consumes a disproportionate share of costs and is a logical target for efforts to promote value in health care.^9,10 Recently, Consumer Reports launched a new online tool that rates the relative "aggressiveness" (or inefficiency) of US hospitals,¹¹ based on the average intensity and cost of inpatient care in the last 2 years of life of chronically ill Medicare beneficiaries, as reported in the 2008 Dartmouth Atlas.¹² This new measure is the primary focus of this review, which includes an assessment according to the recently published American Heart Association (AHA) and American College of Cardiology (ACC) standards for public reporting of efficiency measures.¹³ Alternate measures including risk-adjusted cost savings and avoidance of nonrecommended care are also discussed and compared.

	The 2008 Dartmouth Atlas

 
Wennberg et al¹² retrospectively measured inpatient costs over the last 2 years of life in Medicare beneficiaries with serious chronic illnesses—including heart failure (CHF), lung disease, cancer, dementia, vascular disease, kidney disease, and liver disease—who died between 2001 and 2005 after receiving care at nearly 3000 US . . . [Full Text of this Article]