Diagnosed five years ago with congestive heart failure, a chronic weakening of the heart, Adenis has beaten the odds and gives full credit to Shah for saving his life -- again and again.
"Dr. Shah and his doctors have been able to keep me well," he said.
Known as hospital "frequent fliers," heart failure patients typically cost Medicare $24,000 in inpatient expenses annually. To patients like Adenis, it's money well spent.
But a 2006 Dartmouth study contended that almost a third of the money spent on the chronically ill was wasted on "rescue medicine" for people with advanced diseases who could not be cured.
Shah questions that logic.
"Letting people die early is actually more cost effective," said Shah, who heads the cardiology unit at Cedars-Sinai Heart Institute. "But that's a perverted way of looking at things."
Still, when Dartmouth reported that Cedars' costs were higher than those at other teaching and research hospitals, Cedars took note. The study said Medicare spent an average of $71,637 per chronically ill patient over the last two years of life on hospital care at Cedars. At nearby UCLA, the figure was $63,900.
By comparison, the figures for the Cleveland Clinic and Mayo were, respectively, $34,437 and $34,372.
"The implication was that we were spending resources on care that was not necessary," Cedars' Langberg said.
So Cedars joined with the UC hospitals to investigate the costs and outcomes of patients admitted to their facilities. They studied heart failure patients who lived and died.
They found that the hospital with the most aggressive and expensive practices had the lowest death rate -- more surviving patients -- six months after initial admission. The inverse also was true: The hospital where physicians did the least had the highest death rate.
Next, the Cedars-UC researchers want to study what courses of treatment produce the best results, to improve the way physicians handle the costliest patients.
"We want to know why patients seem to do better at one hospital versus another, and we want to know whether there is a causal relationship between resource use and mortality," Cedars' Langberg said. "We don't know that yet."
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Times staff writers Doug Smith and Sandra Poindexter contributed to this report.
