'Jaw-dropping': Medicare deaths, hospitalizations AND costs reduced

Liz Szabo | USA TODAY

The U.S. health care system has scored a medical hat trick, reducing deaths, hospitalizations and costs, a new study shows.

Mortality rates among Medicare patients fell 16% from 1999 to 2013. That’s equal to more than 300,000 fewer deaths a year in 2013 than in 1999, said cardiologist Harlan Krumholz, lead author of a new study in the Journal of the American Medical Association (JAMA) and a professor at the Yale School of Medicine.

“It’s a jaw-dropping finding,” Krumholz said. “We didn’t expect to see such a remarkable improvement over time.”

Researchers based the study on records from more than 68 million patients in Medicare, the federal health insurance program for people age 65 and older.

Researchers were able to find additional information about hospitalization rates and costs among Medicare’s traditional “fee-for-service” program, in which doctors and hospitals are paid for each procedure or visit. This information wasn’t available for people in the managed-care portion of Medicare, which had about 29% of patients in the overall Medicare program in 2013.

Among fee-for-service patients, hospitalization rates fell 24%, with more than 3 million fewer hospitalizations in 2013 than 1999, Krumholz said. When patients were admitted to the hospitals, they were 45% less likely to die during their stay; 24% less likely to die within a month of admission; and 22% less likely to die within a year, the study found.

Costs for hospitalized patients also fell by 15% among fee-for-service patients.

Krumholz said these improvements are probably driven by several important trends.

Hospitals and their staffs get some of the credit. “There has been tremendous focus on making sure that our hospitals are safer and that treatments are more timely and effective,” Krumholz said.

A 1999 report from the Institute of Medicine, which found that hospital errors killed up to 98,000 people a year, jump-started a movement to improve health care, said P.J. Brennan, chief medical officer at the University of Pennsylvania Health System. “That was one of the first shots fired in the patient safety movement,” said Brennan, who was not involved in the new study.

Public health improvements also likely played a part in cutting death rates, Krumholz said. While more Americans today are obese than in the 1990s, the air is generally cleaner and fewer people smoke. New drugs for common conditions such as cancer and heart disease also may have kept people alive longer.

“What’s gratifying is the cost savings don’t appear to have come at the expense of quality,” said Helen Burstin, chief scientific officer at the National Quality Forum, a non-partisan group that aims to improve the quality of health care.

Burstin said she hopes the country will expand its efforts to improve health care quality by focusing on outpatient care, such as that given in nursing homes or by home health aides.

Krumholz said his results shouldn’t encourage complacency.

“The things we’re trying to do to make things better are working,” Krumholz said. “Rather than wave the victory flag, we want to see that trend continue. There’s no reason to take our foot off the pedal.”