Major overhaul need in dealing with chronic illness

According to a new study by the Center for the Evaluative Clinical Sciences at Dartmouth Medical School, an overhaul for how the U.S. manages chronic illness is critical. This comes on the heels of a report by Medicare's trustees that the insurance program will exhaust its trust fund in 2018.

Here are some tidbits from the study:

• of the 4.7 million chronically ill Medicare enrollees in the study, $40 billion (or nearly one third of what it spent for their care over four years) could have been saved if all U.S. Hospitals practiced at the high-quality/low-cost standard set by the Salt Lake region.

• most acute care hospitals have become first-line providers of services to chronically-ill elderly, whose care would be better managed, safer, and less expensive, outside the hospital setting.

• there are no recognized evidence-based guidelines for when to hospitalize, admit to intensive care, refer to medical specialists, or for most chronic illness, when to order diagnostic or imaging tests.

• Salt Lake, UT, Rochester, MN, and Portland OR had the best quality and outcomes even they were considered low cost regions.

• chronic illness was studied because 30 to 35 percent of Medicare dollars are spent on people with these conditions during the last two years of their lives.

• the report speaks clearly to redirect resources away from acute care and invest in an infrastructure that can better coordinate and integrate care outside of hospitals, such as home health and hospice care.