Second, Chuang based his work on actual hospital costs, rather than on the amounts that hospitals charge for patients. "Most previous studies have looked at charges because it's hard to measure costs accurately," Chuang says. "Since costs are usually assigned to departments rather than individual patients, in order to do a study like this, we had to have a specific system that could attribute costs to patients."

Other studies that have evaluated Medicare reimbursement systems have examined factors such as a patient's age, sex and income. In these studies, costs have been found to vary by about 3 to 10 percent between groups. "No other study has found cost differences as high as those we found between dependent and independent patients," Chuang says. "While cost differences below about 10 percent could end up balancing out between groups, that's not the case with differences as high as those we found. I was really surprised by the magnitude of our results."

Other investigators in the study include senior author Seth Landefeld, MD, associate chief of staff for geriatrics at SFVAMC, professor and chief of geriatrics at University of California, San Francisco, and Senior Scholar in the Department of Veterans Affairs National Quality Scholars Program; Kenneth Covinsky, MD, MPH, staff physician, Division of Geriatrics, SFVAMC and associate professor of medicine, UCSF; Laura Sands, PhD, School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN; Richard Fortinsky, PhD, Center on Aging, University of Connecticut Health Center, Farmington, CT; and Robert M. Palmer, MD, MPH, Section of Geriatric Medicine, Cleveland Clinic Foundation, Cleveland, OH.

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Contact: Liese Greensfelder
lgreensfelder@pubaff.ucsf.edu
415-476-8429
University of California - San Francisco
18-Dec-2003

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