John W. Poole/NPR
Dr. Elliott Fisher defends the Dartmouth Atlas' methods and findings.
Even if you're not a hardcore health care geek, you've probably heard that Medicare spends a lot more on patients treated in Miami and McAllen, Texas, than those cared for in Minneapolis or Sacramento, Calif.
For decades, the folks behind the Dartmouth Atlas of Health Care have documented wacky variations in how frequently different medical procedures are performed and how much money gets spent across the U.S. And the underlying question is: What are patients getting for the extra money?
The group's work was thrust into the public spotlight by a New Yorker article written by Dr. Atul Gawande and the administration's push for health overhaul. The message, as summarized by OMB Director Peter Orszag: "higher cost areas and hospitals don’t generate better outcomes than the lower-cost ones."
Now, the New York Times raises questions about Dartmouth's work. Quality of care provided isn't part of the standard Dartmouth formula, the paper writes, so maybe patients are dying more often in places where hospitals spend less.
"As any shopper knows, cheaper does not always mean better," the Times writes.
Dartmouth researchers explained their methods in some detail in a document the Times posted alongside the article.
But upon publication of the Times report, Dartmouth posted a rebuttal: "Shaky Data? No. Shaky Reporting." Researchers Elliott Fisher and Jonathan Skinner cite five "factual errors" and a bunch of misrepresentations in the Times story. The upshot? The researchers stand by their central finding:
There are marked variations in spending observed across both hospitals and regions that are largely due to how much time similar patients spend in the hospital, how many specialists they see, and how many diagnostic test they receive. On average – across the United States – health systems that spend more on these services are less likely to deliver safe and effective care.
The New Republic's Jonathan Cohn weighed in with a measured and pithy analysis of the power and limits of the Dartmouth approach when it comes to making changes in health care:
[T]he fundamental argument of reform is not ... that cheaper care is better care. The argument is that cheaper care can be better care—or, at least, equally good care. And the evidence for that proposition is pretty overwhelming.
When it comes to health care, nobody we've met has all the answers. But it's hard to imagine tackling the problems of cost and value without looking at the differences in what gets spent where — and to what end.
Last October, NPR's Alix Spiegel took a look at the how the Dartmouth Atlas got its start. As she reported then, most Americans find it "incredibly difficult" to accept "that more care isn't necessarily better for you."
Yet, she reported, "study after study has borne out the truth of this completely anti-intuitive conclusion." And Dartmouth's Fisher and others figure almost a third of the care given isn't really helping people.