The issue of geographic payment disparity in the Medicare program is once again in the headlines, and it’s good news for Iowa that this fight continues to be fought. 

As many Iowans know, our state’s hospitals spend far less (and receive far less) Medicare funds than most other states.  The Dartmouth Atlas of Health Care has documented that higher-spending hospitals and states are not providing any better care and, in fact, much of that extra spending is simply wasted.  The White House and much of Congress is in agreement, and this is making some high-spending hospitals nervous, the New York Times reports: 

The issue pits hospitals in more rural states like Iowa and Minnesota, where spending tends to be lower, against those in areas like New York City and Los Angeles, and revolves around a question that has bedeviled the medical establishment for decades: how much money do hospitals need to provide adequate care for patients…

Urban hospitals are countering that they serve poorer, sicker patients.  But that does not explain why similar hospitals – such as highly regarded academic medical centers in urban areas – have extraordinary differences.  Take a look at the table below (this information all pertains to Medicare patient averages during the last two years of life): 

Hospital	Physician visits	Medicare spending	Days in the hospital
Barnes-Jewish Hospital (St. Louis)	61	$63,281	27
Cleveland Clinic	63	$55,333	24
Hospital of the University of Pennsylvania	72	$80,727	31
Johns Hopkins Hospital	57	$85,729	29
Massachusetts General Hospital	75	$78,666	29
New York-Presbyterian Hospital	83	$91,113	39
UCLA Medical Center	101	$93,842	32
UCSF Medical Center	63	$78,046	22

 

These hospitals all happen to appear at the top of U.S. News & World Report’s “Best Hospitals” list and they all serve very urban populations.  Yet the differences are stark and raise many questions.  Why, for example, are patients spending 10 more days at UCLA Medical Center then its sister institution in San Francisco?  Why are 26 more physician visits needed at New York-Presbyterian than Johns Hopkins? 

Now, just for perspective, here are the numbers for Iowa’s major medical centers, along with the overall U.S. average: 

Hospital	Physician visits	Medicare spending	Days in the hospital
Alegent Health Mercy Hospital	58	$40,831	20
Allen Memorial Hospital	47	$39,386	18
Covenant Medical Center	57	$41,998	18
Finley Hospital	56	$38,696	19
Genesis Medical Center	58	$39,964	25
Iowa Methodist Medical Center	66	$44,068	25
Jennie Edmundson Memorial Hospital	65	$40,357	22
Mercy Hospital	47	$31,229	20
Mercy Medical Center-Cedar Rapids	52	$36,590	20
Mercy Medical Center-Des Moines	73	$42,091	24
Mercy Medical Center-Dubuque	47	$32,403	16
Mercy Medical Center-Mason City	43	$37,920	14
Mercy Medical Center-Sioux City	57	$42,272	22
St. Luke’s Hospital	50	$37,263	20
St. Luke’s Regional Medical Center	59	$37,581	19
University of Iowa Hospitals & Clinics	51	$48,427	24
U.S. Average	70	$52,838	25

 

One last thing:  Though it’s convenient from a media perspective, this is not necessarily an urban vs. rural issue.  There are, as the tables above show, urban hospitals that are providing value to the Medicare and there are rural facilities that are extreme outliers when it comes to Medicare spending.  The point is it is time for Medicare, as a health care consumer, to seek out and reward value – wherever it is found.