Where’s the AHA been?
Wait a second! Did I read that right? Did Nancy Foster, vice president of quality and patient safety policy for the AHA, say that, “It’s hard to tell what’s going on and whether there are higher costs in some regions because patients don’t have ready access to primary care,” and that it’s “the first time we are seeing this kind of thoughtful comparison”? (“Cash for care,” April 30, p. 8.) Where has she been? The RAND Corp. and the Dartmouth Atlas have been publishing these data for decades. And in the hospital community, we’ve known about these wide geographic practice variations but have done little to attack them. ( Remember Dr. Atul Gawande’s Mcallen, Texas article in the New Yorker that President Barack Obama quoted during the reform debate?) And we also know it’s not because of a lack of primary care, but rather because of what Dartmouth’s Dr . John Wennberg calls “preference- sensitive care” and “supply driven care”—or, put more bluntly, physician practice habits and “if you build it, they will come.”
As for me, I’m delighted to see that the CMS is adding Medicare spending per beneficiary as a new efficiency metric. In the hospital setting, it’s a more valid indicator than the C-suites slavish focus on length of stay.
Stefani Daniels Managing partner Phoenix Medical Management
Pompano Beach, Fla.