Atul Gawande's Latest, On The Most Expensive Patients

Honest, we don't get any commissions from The New Yorker for getting more people to subscribe, but maybe Atul Gawande should. His incisive pieces on aspects of the health care system ranging from end-of-life care to medical costs are must-reads for their mix of analysis and humanity.

His latest is just about to come out in the Jan. 24 issue (see the New Yorker link and summary here.) It's titled "The Hot-Spotters" and describes innovative efforts to improve care for the super-expensive patients whose complex needs suck up a huge portion of the health care budget.

The New Yorker has put up a digital pay-wall, so you can't read the whole article online without subscribing. But I can spill that it has a small local angle: a mention of a Massachusetts General Hospital program led by Dr. Tim Ferris that has found ways to improve care and cut costs for some of their most expensive Medicare patients. And The New Yorker site is advertising a live chat on medical costs this Thursday at 1 p.m. Here's another little teaser from the magazine's summary of the piece:

Writer tells about Jeffrey Brenner, a physician in Camden, New Jersey, who has used data mining and statistical analysis to map health-care use and expenses. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients. In his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs.