Both the left and the right hew to narratives about healthcare that comport with their worldview rather than mechanism-based analysis of treatment outcomes or evaluation of the impact of technological innovation on such interventions. Both make the assumption, badly mistaken, that quality reduces cost. Both base this mistaken assumption on the flawed Dartmouth Study that has peddled the falsehood that less care is actually better.
Peter Orszag was the peddler in chief of this notion, stating that the Dartmouth research demonstrates that at least $700 billion in health care spending is wasted each year. CMS commissar Berwick, with usual hyperbole, says that Dartmouth research shows that HALF of all health care could be eliminated and that doing do would improve outcomes.
Such statements are made in the face of research that both cite. And when they encounter a finding that conflicts with their narrative, they simply ignore it, even when citing the literature.
The most recent example is Orszag's oped in the NY Times today (Health Care’s Lost Weekend) tinyurl.com/27sfn7v
"The Dartmouth data also indicate that the N.Y.U. patients received no clear benefit for the higher cost. They saw, on average, more than 14 different doctors, compared with fewer than 10 for patients at the most efficient hospitals. But the extra visits did not seem to produce better outcomes. In fact, seeing more doctors may have caused harm, as patients ran the risk of side effects and complications from additional tests, treatments and medicines."
But Orszag cites an article in the NEJM that proves the opposite, en route to making his point.
First, weekends. It’s never good to be hospitalized, but you really don’t want to be hospitalized on a weekend. There are fewer doctors around, and people admitted on Saturdays and Sundays fare relatively poorly.
One study in 2007 found, for example, that for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday. The weekend patients were less likely to quickly receive the invasive procedures they needed — like coronary artery bypass grafts or cardiac catheterization.
Except that the study concludes the more care leads to better outome not that more people receiving care quickly:
Overall, mortality 30 days after admission was significantly higher for patients admitted on weekends than for those admitted on weekdays...Patients admitted on weekends were less likely to undergo invasive cardiac procedures than were those admitted on weekdays....the worse outcome of weekend admissions may be due in part to a lower rate of invasive intervention.
www.nejm.org/doi/full/10.1056/NEJMoa063355#t=articleTop
This article is consistent with other studies , including those by PCORI governor Dr. Harlan Krumholz, showing that the rate of invasive intervention, once severity of illness is adjusted for, saves lives and improved outcomes
The key variable shaping re-admissions: intensity of interventional care. The shorter the stay and the fewer the procedures, the more readmissions there were.
jama.ama-assn.org/cgi/content/short/303/21/2141
When it comes to invoking quality, both the right and the left should be more circumspect about clalming it can save money. And Orszag, who perpetuated this myth, ought to lead the charge.
