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Published at www.nejm.org November 11, 2009 (10.1056/NEJMopv0908995)

Dead Souls — Comparing Dartmouth Atlas Benchmarks with CMS Outcomes Data

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The premise, based on the Dartmouth Atlas of Health Care, that geographic variations in end-of-life Medicare spending can be used to identify wasted resources was popularized by Peter Orszag, director of the Office of Management and Budget, who has said that "30 percent of Medicare's costs could be saved without negatively affecting health outcomes."1 This belief has been propagated by well-meaning adherents seeking a means of financing the expansion of health coverage. Institutions such as Cedars-Sinai Medical Center in Los Angeles (where we work) and New York University (NYU) Medical Center have been portrayed as excessively costly,2 while "model systems" . . . [Full Text of this Article]



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