Thursday, June 3, 2010

Apparent Inconsistencies: Dartmouth, The Truth and Health Care

In today's NY Times there is a detailed article which begins to chip away at the Dartmouth data used by the White House and others to justify the changes made to our health care system. It states:

In interviews, Dr. Fisher and Mr. Skinner acknowledged that there was no proven link between greater spending and worse health outcomes. And Dr. Fisher acknowledged the apparent inconsistency between his statements in interviews with The New York Times and those made elsewhere, saying that he was sometimes less careful in discussing his team’s research than he should be.

Apparent inconsistencies my foot! I have spent time in Hanover and had come to know Dartmouth and in my opinion these most likely were no inconsistencies but a political agenda. The article goes on to state:

Similar problems arise with Dartmouth’s regional data. In Dartmouth’s rankings, for instance, New Jersey comes in dead last because its costs per Medicare beneficiary are the nation’s highest. And yet, for the quality of care offered in New Jersey, independent of cost, federal health officials rank New Jersey second only to Vermont.

The good Dartmouth physicians would have us reduce compensation in New Jersey, the state with the highest population density and proximate to New York and Philadelphia based upon their less than consistent data!

We have been making this argument for well over a year. Yet selective data presentation was used in an ad hoc propiter hoc fashion. The results will penalize people in their pocket books and in their very lives!

The article states:

In other words, there is little evidence to support the widely held view, shaped by the Dartmouth researchers, that the nation’s best hospitals tend to be among the least expensive.

In interviews, Dr. Fisher and Mr. Skinner acknowledged that there was no proven link between greater spending and worse health outcomes. And Dr. Fisher acknowledged the apparent inconsistency between his statements in interviews with The New York Times and those made elsewhere, saying that he was sometimes less careful in discussing his team’s research than he should be.

In any case, the more-is-worse message has resonated with insurers, whose foundations now help to finance the Dartmouth Atlas. Dartmouth researchers also created a company, Health Dialog, to consult for insurers and others on Dartmouth’s findings. Valued at nearly $800 million, the company was sold to a British insurer in 2007 and still helps to finance the Dartmouth work.

The essence of the study as apparently promulgated by Dartmouth was less is better. The truth appears to be far from what they stated. Here is a clear case worthy of Congressional investigation. Where is the good Congressman Dingell who went after David Baltimore with a vengeance, there seems to be a smoking gun here, especially if the Times spends so much space on it.