Data Guy: 

No one disputes that there is variation in care and outcomes in the US and that variation manifests in many, many different ways. Most of us have been staring that variance in the eye for well over two decades. Some of us have even been doing something about it on a national scale.

One way to look at variation is to study Medicare spending per capita and to declare that if spending is high, and not justified by outcomes (controlling for age, gender, and other socio-economic factors) that it is a bad thing, and most might agree. It sounds logical and consistently plays out for the dozen or so years that the Dartmouth Atlas Project has been pushing for reform. Same model, same results no surprise there.

Others, especially those who build systems, collect data for analysis, test hypothesis, build models, teach physicians about variance and get their hands dirty every day with the “change” thing, know that the “stick approach” is nothing other than bad policy. What they also object to is the abject approach that if the spending says so then it is true!

I don’t have to cite examples of government data and research that points to illogical spending, reimbursement or taxation for that matter to make my point any more clear.

The simple point gentlemen is that there is no one single thing that makes McAllen,  East Long Island, Grand Junction or Rochester exceptionally good or bad, except that they are at similar points on some researchers pole that doesn’t adjust for all variables.

The reason that there is a Blog on The Hospital Value Index site is to also bring awareness to the multi-variant points of light that make health care unique from one place setting to another.  The more we refine the analyses, and the better the data and methodology become, the closer we get to root cause. But until then, let’s stay focused on some key factors; utilization, safety, satisfaction, process measures, risk adjustment for case severity, efficiency, outcomes  and price (and maybe a few other things) all matter! AND when building models and drawing conclusions it is more helpful to have complete, current and accurate data! GIGO is what we once called it, “garbage in, garbage out”.

Where the rubber hits the road is not with the researcher’s ego and political affiliation or even source of funding and grants, but with what we all can learn and deploy when we working stiffs go into hospitals and try to re-train the physicians and staff; most of whom weren’t taught anything about economics while they were studying for their Board certification. It may be just that easy…or not!

If you have a better point to make, go build something like RWJ funded at Dartmouth, or invest a couple million dollars and try to create your own engine like we did. I personally appreciate your contributions and look forward to your results.

John R. Morrow

Founder: The Hospital Value Index™, 100 Top Hospitals:Benchmarks for Success®, The Patient Satisfaction Index™