Health 2.0

The NY Times, dogs, sores & Dartmouth critics

Today’s NY Times has a confused, woffly attack on Dartmouth from Reed Abelson & Gardiner Harris. This is a dreadful article. Period.

That the NY Times printed it is remarkable given the turnaround in thinking by David Leonhart in the Economix blog on the NY Times over the years to being a thoughtful Dartmouth proponent. It’s end even more remarkable that they didn’t even quote Buzz Cooper, probably the leading thoughtful Dartmouth critic. Longtime THCB readers will expecting me to start writing about dogs licking their sores….

Dartmouth has pretty much immediately refuted their article (and I suspect it didn’t take too much research). But what they really missed was the big announcement yesterday that HHS is now releasing a whole lot of datasets that researchers can use to put these and other data together and are encouraging the private payers to add to the mix (FD The Health 2.0 Developer Challenge is helping convene tech developers to work on this). Is it really true that Sacramento is cheap according to Dartmouth but expensive to private payers. And why?

There’s lots more work to be done here, but this article doesn’t help.

If you want a deep deep dive into this problem, here’s the article Daniel Gilden wrote on my blog last year. With lots of intelligent back and forth in the comments (including one from a Nobel Prize winner!).

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dr. dog skin care for dogsInspiro AssistantTRGOnline cpr trainingutah doc Recent comment authors
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dr. dog skin care for dogs
Guest

One more thing. I think that there are numerous travel insurance web pages of reliable companies that permit you to enter holiday details and have you the prices. You can also purchase the particular international holiday insurance policy on the internet by using the credit card. All you have to do is to enter your current travel specifics and you can see the plans side-by-side. You only need to find the plan that suits your financial budget and needs after which use your credit card to buy the idea. Travel insurance online is a good way to take a look… Read more »

Inspiro Assistant
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What’s bugging me is that the government has added laws and its getting crazy. I do hope that this medical reform will work out. People are already getting confused with the new things.

TRG
Guest
TRG

Matt, Your June 25, 2009 post RE: Dan Gilden’s analysis of a “Tale of Three Counties” was predictive of a huge risk that we now face. Gilden’s insights were spot on. The fact is as you said “Finally it’s worth noting that if his conclusions are true this has huge implications for overall health care policy”…Matthew Holt. I think the NYTimes got the last word for those late viewers, and they finally reported what needed to be said the first time around. And BTW, the data that Dartmouth uses will NOT be released, so we will have to rely on… Read more »

Online cpr training
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A variety of new technologies have been developed over the past decade to assist in this goal.

jd
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Utah doc, healthier people is not a significant factor in the Dartmouth results because it has been controlled for in many of the Dartmouth studies. I am sure that you are right that cultural factors play a major role in practice patterns. But the Dartmouth researchers never deny that, do they? Similar cultural factors also play a role in Minnesota and other states where costs are lower. But cultural factors show themselves in the practice of medicine. If someone argued that financial incentives were the only significant variable making some areas high cost and others low cost, you would be… Read more »

utah doc
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utah doc

The Dartmouth research has helped raised important questions about regional variation and possibly unnecessary health care. But the conclusions drawn from their data are often a stretch. In Utah the Dartmouth data shows that the lower cost of care is similar across the four major hospital systems that operate here. And CMS Hospital Compare data shows that none of those four systems is systematically outperforming the others on quality metrics. Furthermore the rate of increase in health care premiums in Utah is the same as elsewhere. But Intermountain is always highlighted by Dartmouth and others as an innovator in cost… Read more »

Bart
Guest

Anyone who has seriously published in NYT knows, they triple-check something this big. This is just the tip of the iceberg.

Bart
Guest

“Dartmouth is far from perfect and could use so questioning, clearly academic exercise from people not involved in healtcare. If they are forced to explain and back up their results it can only help them.”
Yes. Along with “I’m from the government, and I’m here to help.”
NYT would never have gone with that story, unless it was double-checked by several editors and a few statisticians. This is just the tip of the iceberg. Look for more — a lot more.

Nate
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Nate

“There’s lots more work to be done here, but this article doesn’t help.” Are you taking the global warming stand her Matt? Don’t dare question the science we don’t have time to prove ourselves. Sience is built on questioning, vast majority of which are wrong but by proving so you establish the facts. Unless your pushing propoganda over science you shouldn’t fear 1 poorly written and reserached article. Seeing what a couple questions have done to the global warming politics I can see why you would worry though. Dartmouth is far from perfect and could use so questioning, clearly academic… Read more »

Steve Auerbach, MD, MPH
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Steve Auerbach, MD, MPH

My main criticism of Dartmouth work and especially some of the use it has been put to is its mostly ignoring (and then being used to deny by others) the real problem of the UNDERserved. With its focus on inpatient care and those who have already managed to get their way into care, it misses (and is then used to deny) the issues the lack of acces to primary care, the existance of medically underserved areas and populations, health professional shortage areas. Hence we get the emphasis on the “overtreated” as a convenient way to cut costs while ignoring health… Read more »

Devon Herrick PhD, National Center for Policy Analysis
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Devon Herrick PhD, National Center for Policy Analysis

I do not view the New York Times articles as a hatchet job as much as a critique of the strength and weaknesses of Dartmouth research. It is a little too simplistic to assumption that saving $700 billion annually is as easy as telling high-cost hospitals to merely perform medical services like Intermountain, Geisinger or the Mayo Clinic. Moreover, Medicare may not be a good proxy for non-Medicare health care spending in many areas. Thomas Saving, Andrew Rettenmaier and their colleagues at Texas A&M University found that variations in Medicare spending are often offset by non-Medicare spending. For instance, although… Read more »

Steve Auerbach, MD, MPH
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Steve Auerbach, MD, MPH

From: “Dr. Steve A” Date: June 4, 2010 8:01:45 AM EDT Subject: fyi: the real problem with Dartmouth My main criticism of Dartmouth work and especially some of the use it has been put to is its mostly ignoring (and then being used to deny by others) the real problem of the UNDERserved. With its focus on inpatient care and those who have already managed to get their way into care, it misses (and is then used to deny) the issues the lack of acces to primary care, the existance of medically underserved areas and populations, health professional shortage areas.… Read more »

praetorius
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praetorius

Interesting businesses: Dartmouth researchers who have published misleading data and opinion enrich themselves by selling a company they formed to proselytize its dogma; and Don Berwick (CMS Director nominee) wrote the misleading IOM report using flawed methodology and formed a “safety” non-profit company at which he earns nearly $2 million. Hmmm.
Foundations of health care reform are cracked. Is it no wonder the problems continue while patients suffer?

jd
Guest

Another gem: The researchers also say they have made some of those adjustments in some of their other published work. How about actually reading that work and evaluating it? It’s published, so not hard to find. It appears that the authors’ sympathies lie with providers and defending the status quo ante of high payments to them. This passage is ripe with insinuation that trying to control costs and utilization is bad because insurers are for it: 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… Read more »

bev M.D.
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bev M.D.

This article unfortunately demonstrates how poorly educated most Americans, as represented by reporters, are in understanding basic statistics and how to read charts and graphs.
It also smacks of the same political machinations practiced by those, including many medical professionals (read, American College of Physicians), who attempted to debunk the IOM’s report on the number of deaths per year from medical errors.
Make no mistake; these are deliberate attacks promulgated by those invested in maintaining the status quo. See Clayton Christensen’s book on disruptive innovation and how the “establishment” tries desperately to maintain status quo in times of change….