2002

Will Volume-Based Referral Strategies Reduce Costs or Just Save Lives?

Health Affairs
Birkmeyer J., Skinner J.S., and Wennberg D.

Although recent policy initiatives aimed at concentrating selected surgical procedures in high-volume hospitals may reduce mortality, their economic implications have not been considered fully. From the hospital perspective, the primary effect of these policies will be to redistribute surgical profits to bigger centers. From the payer perspective, prices paid for procedures will likely increase in some geographic areas. From the societal perspective, how these policies will affect the true cost of providing surgical care is uncertain, but use of discretionary procedures will likely increase. For these reasons, the primary argument for volume-based referral strategies should be improving quality, not reducing costs.

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Design of the Spine Patient Outcomes Research Trial (SPORT)

Spine
Birkmeyer N.J., Weinstein J.N., Tosteson A.N.A., Tosteson, T.D., Skinner J.S., Lurie J.D., Deyo D.A., Wennberg J.E.

The Spine Patient Outcomes Research Trial (SPORT) was designed to assess the relative efficacy and cost-effectiveness of surgical and nonsurgical approaches to the treatment of common conditions associated with low back and leg pain.

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Geography and the Debate Over Medicare Reform

Health Affairs
Wennberg JE., Fisher E.S., and Skinner J.S.

Medicare spending varies more than twofold among regions, and the variations persist even after differences in health are corrected for. Higher levels of Medicare spending are due largely to increased use of “supply-sensitive” services–physician visits, specialist consultations, and hospitalizations, particularly for those with chronic illnesses or in their last six months of life. Also, higher spending does not result in more effective care, elevated rates of elective surgery, or better health outcomes. To improve the quality and efficiency of care, we propose a new approach to Medicare reform based on the principles of shared decision making and the promotion of centers of medical excellence. We suggest that our proposal be tested in a major demonstration project.

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