HL20: John E. Wennberg, MD—Variations in Care and the Constant Search for a Better Way
In a 2004 study of 77 of the country's top hospitals, Wennberg and his colleagues reported what he termed "huge differences" in the management of patients with chronic conditions during the last six months of life. Nationwide, Wennberg reported that hospital days per patient during the last six months of life ranged from 9.4 to 27.1, the number of physician visits from 17.6 to 76.2, and the percentage of patients who saw more than 10 physicians ranged from 15.9% to 58.5%. Even within the same city, different hospitals revealed significant differences in "patterns of patient management," Wennberg wrote.
"That's the whole nub of the issue," Wennberg says. "It's the intensity of treating chronically ill patients that is responsible for differences in spending in places, such as Los Angeles and Minneapolis, among Medicare populations."
With findings like these, Wennberg and his colleagues have generated many headlines, and continue to reach a wide audience, as an integral part of the nation's burgeoning discussion on healthcare reform. While healthcare leaders are listening about the problems of variation of care, that doesn't mean the problems are solved, he says.
"There's been a lot of progress: Not that there has been a substantial change in the variation problem," Wennberg says, "but there's been a lot better understanding of the causes of it, and the remedies we need to put into place to actually reduce variation."
Eventually hospitals and health systems, as well as doctors and other healthcare professionals, must look beyond the costly and unnecessary procedures, but also at the money spent for increasing capacity that may not be justified by the need, Wennberg says.
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