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Merrill Goozner Is Unhappy with Abelson and Harris of the New York Times

Goozner:

Dartmouth Analysis Again in the Cross-Hairs: Reed Abelson and Gardiner Harris in the New York Times are questioning some of the key assumptions behind the Dartmouth Atlas of Health... they write:

For all anyone knows, patients could be dying in far greater numbers in hospitals in the beige regions than hospitals in the brown ones, and Dartmouth's maps would not pick up that difference. As any shopper knows, cheaper does not always mean better....

This is an important debate. But as is often the case in journalism, the attempt to reduce complex realities into a single-factor analysis that can be summarized in a headline or a single "why this story is important" paragraph can leave a mistaken impression. Regional variation in Medicare spending is one indicator of gross overutilization. Something is happening when a hospital in McAllen, Texas does twice as many knee implants per Medicare beneficiary as a hospital in Rochester, Minnesota.

But that by itself tells us nothing about why that overutilization occurs. Greedy doctors or hospitals working in a fee-for-service system are part of the problem. Cost shifting due to high levels of uninsurance and illness severity also may account for some or even much of those differences....

My complaint with today's story... [is that h]igher quality care lowers costs, it doesn't raise costs. Take a few additional steps to keep operating rooms germ free and rates of hospital-acquired infections and their attendant higher costs plummet. Do a knee implant right the first time and you don't have a patient back within a year for a revision. A careful mapping of quality has never been done by Medicare or anyone else since good data isn't available...

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