Where’s the AHA been?

Modern Healthcare - - OPINIONS LETTERS -

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.

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