Here we go again,the enemy of good is perfect.
In the following article in the New York Times the Dartmouth Atlas data and results are being questioned as valid. Give me a break! This is the most studied healthcare data base on earth and it has been available for 20 years so all researchers have been able to poke holes in it or make it better depending on their inclination.
It's preposterous for someone to claim at this point that we can't trust this information or that it is fatally flawed after 20 years of vetting it and improving it. The only valid point in this article is that the data base is unable to make true determinations of quality performance.I do agree that obtaining quality performance from administrative claims(The Dartmouth data is derived form Medicare patient claims) is difficult. However, this data was never purported to address quality performance. This point is important though.We need a quality outcomes public report to accompany the Dartmouth data.The only good one is the Wisconsin Collaborative for Healthcare Quality which is also mentioned in the article(they got something right).
Once we have a clinical data base available and then use the Dartmouth data we will then have a way to determine value for communities.In the meantime all we can say is that certain communities are three times less efficient than others.According to the Dartmouth data care in Miami is around $17000/yr for a Medicare enrollee,in Appleton it's about $6100. When I practiced medicine most of my snow birds would not step foot in a Miami hospital due to the poor impression they had of Florida hospitals in general and Miami in particular. There may have been some basis for their belief but no one could ever prove it because we didn't have an accurate quality data base to compare. We still don't, so all we can say is Miami is three times more expensive than Appleton and all we can do is speculate. My final comment is every doctor I have ever talked to has told me his/her patient's are sicker. It's never turned out to be true in 30 years so I won't buy that argument either.
Read on!
http://www.nytimes.com/2010/06/03/business/03dartmouth.html
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