The reason? Sharp differences in how long patients spend in the hospitals during the final two years of their lives and how often they see doctors, say researchers at the Dartmouth Institute for Health Policy and Clinical Practice.

The study comes amid rising health care costs and a report by Medicare's trustees that the program's hospital fund will go broke in 11 years. The report says taxpayers could save billions of dollars if hospitals practiced more efficiently.

Teaching hospitals, affiliated with medical schools, train the next generation of doctors and typically deal with complex cases and use cutting-edge technology.

Elliott Fisher, the report's co-author, says the study does not specify the "right" number of days patients should be hospitalized in their last months. Rather, he says, the big differences between hospital systems indicate there is room to improve efficiency, save money and spare some patients from what may be unnecessary hospital stays.

"These are all high-quality medical centers, but it's amazing the differences in practices among them," Fisher says.

Researchers used data on 192,242 Medicare patients treated at teaching hospitals who died between 2001-2005, comparing the length of hospitalization, the number of doctors treating them and the time they spent in intensive care units during the last two years of their lives. All had at least one of nine chronic conditions, such as congestive heart failure or diabetes.

Earlier Dartmouth studies of teaching hospitals found that patients who spent more days in the hospital than others with comparable conditions had worse five-year survival rates for hip fractures, heart attacks and colon cancer.

Among the 93 teaching hospitals studied, the average cost of hospital care over the two years was $67,369 per person.

Researchers also found:

•Hahnemann University Hospital in Philadelphia was the most expensive. Patients spent an average of 34.8 days there.

"The next (Dartmouth) report will show a much lower reimbursement at Hahnemann," said Steven Campanini, spokesman for the hospital's parent company, Tenet. He says the report does not fully reflect lower across the-board charges Tenet adopted nationally in 2003 after federal investigators alleged the company unfairly raised prices to collect special payments from Medicare.

•Scott & White hospital in Temple, Texas, was the least expensive, and patients spent an average of 15.9 days there.

David Lindzey, Scott & White associate chief medical officer, credits use of electronic records and good communication with physicians for the lower costs.

"We have no evidence that, on average, the care in a system like Hahnemann is better than in a conservative system such as Scott & White," Fisher says.

The Dartmouth data may not account for differences among hospitals and the communities they serve, says Atul Grover of the Association of American Medical Colleges, which represents teaching hospitals.

While hospitals that do more than is necessary may reap financial rewards, he adds, "there are clearly parts of the country where people aren't getting the care they need."

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