CHICAGO — An ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn’t work, a government-contracted study found.
The disappointing results show how tough it is to manage older patients with chronic diseases. They take multiple prescriptions, see many different doctors and sometimes get conflicting medical advice.
The study showed just how difficult it is to change the habits of older patients and their sometimes inflexible doctors. And it points up the challenges the Obama administration will face in trying to reform health care for an aging nation.
Most of the patients had serious but common age-related illnesses including diabetes, heart disease and lung disease.
The Centers for Medicare & Medicaid Services selected 15 proposals for test programs, enrolling 18,309 patients.
Only two of them were able to cut the number of times these patients were hospitalized, and those are still in operation. None saved Medicare any money.
The authors of the study called the results “underwhelming.” An editorial in the Journal of the American Medical Association, where the study appears today, used the term “sobering.”
“The only way you can really do it is by changing patients’ behavior and by changing physicians’ behavior, and both things are really hard to do,” said study author Randall Brown, a researcher at Mathematica Policy Research Inc., in Princeton, N.J., which was hired to evaluate the programs.
Often, these patients need to stop smoking or lose weight, exercise more and eat healthier foods. Those changes are a challenge even for generally healthy people. They are especially tough for sick, older patients who often are set in their ways.
“The same thing with physicians,” Brown said. “A lot of them feel like they know how to take care of patients, so why do they need a nurse calling up and asking them why the patient isn’t on some certain medication?”
