Pencils are snapping as Congress struggles to curb health care costs that this year will consume $2.5 trillion, or one-sixth of the economy. Just a few blocks away, though, a meeting took place last week showing it can be done.

Hospitals and health plans from 10 parts of the country met to share ideas on how they do a better job caring for their patients while spending 15 percent to 18 percent less than the national average.

In La Crosse, Wis., 95 percent of seniors have signed advance directives describing the extent of lifesaving measures they'd like once they near death. Since most of an average person's medical expenses occur in the last six months of life, the directives have reduced costs while meeting patient expectations and improving care.

In Everett, Wash., physicians and hospitals reduced pharmaceutical expenses by $88 million by encouraging the use of generic drugs.

Two hospitals facing each other across the street in Asheville, N.C., combined in 1998 and agreed to be treated as a regulated public utility so they could cut down on duplication and live within a budget cap.

In Temple, Texas, the 800 physicians employed by Scott & White Healthcare at nine hospitals and 50 clinics receive monthly reports on the cost and quality of the care they're giving patients. Those doing a better job are eligible for bonuses, while those coming in lower get attention from peers to improve.

Organizers of this meeting sifted expense and quality measures collected by the Dartmouth Institute for Health Policy from 306 hospital regions, and came up with 74 high achievers.

Next, they cut the list to 10. Temple, where Scott & White dominates health care delivery, was the only Texas community even in the running. (Temple spends one-third less than Dallas on Medicare patients but gets some of the highest quality scores in the country from the federal Centers for Medicare and Medicaid Services.)

All 10 communities stressed the importance of coordinating care so that patients aren't seeing too many doctors, getting too many tests and scans or taking too many medicines. Several said they've put together electronic medical records accessible by doctors and hospitals throughout their community that cut the overuse of medical care.

Organizers admitted there are no legislative ways to reproduce nationwide what the 10 communities have done. Mark McClellan of the Washington-based Brookings Institution said Congress should change Medicare's payment system so that it stops rewarding overuse of health care, and then let successful communities teach others how to improve.

One organizer, Don Berwick of the Boston-based Institute for Healthcare Improvement, said even the model communities could learn from each other.

"There is not one answer here," he said. "We don't need one answer. We need lots of them."

All of the 10 communities stressed the importance of a cost-conscious culture of medicine among both patients and physicians.

"We strongly believe that a lot of emergency and inpatient medicine is a failure of outpatient care," said Mark O'Bryant, president of Tallahassee Memorial Healthcare Inc.

A hospital executive from Sayre, Pa., seemed to speak for all of the communities as he worried over whether Congress will get the job done.

"If we fail again in this year to deal with national health care reform, this (cost) trajectory is not sustainable," said Guthrie Healthcare System chief executive Mark Stensager.

Jim Landers is a columnist for The Dallas Morning News.