Experts Question Study Used To Justify Health Reform Law Provisions
Although lawmakers have used the Dartmouth Atlas of Health Care on regional variation in Medicare spending to justify cost-cutting measures in the health reform law, the study oversimplifies the factors driving health care costs, the New York Times reports.
Study Reasoning Questioned
Dartmouth researchers suggest that "cheaper" regions provide higher quality care. However, experts argue that the atlas fails to account for quality
Specifically, critics say regional cost variation often stems from patient health characteristics and cost of living, which affect hospital spending, care delivery and care outcomes. According to critics, although the atlas shows that health care is less expensive in the Upper Midwest and more expensive in urban centers, the study does not address the difference in quality across these regions.
The study has shaped the current outlook on hospital quality by implying that the nation's best hospitals are among the least expensive. Many observers use the study to rank hospitals.
However, hospital administrators point out that the atlas does not account for care that prolongs or improves lives, and distorts rankings by comparing only costs before death, according to the Times. For example, the atlas ranks New Jersey last because of its high costs per Medicare beneficiary, yet federal health officials rank the state second in the nation for quality of care.
Dartmouth researchers maintain that the study never claimed to "judge the quality of care at a hospital -- only the cost," the Times reports.
Putting Findings Into Action
Despite the study's apparent shortcomings, President Obama, legislators and the nominee to head CMS, Donald Berwick, have touted the findings as a remedy for skyrocketing health care costs. Berwick called the atlas "the most important research of its kind in the last quarter-century."
Lawmakers also plan to put the Dartmouth findings into action in the health reform law, which allows the Institute of Medicine to squeeze out wasteful spending by setting payment rates for government health programs and penalizing inefficient hospitals.
However, addressing skyrocketing health care spending is more complex than trimming costs, critics say. If hospitals that spend more deliver better patient outcomes, cutting costs could affect patient outcomes.
Meanwhile, Dartmouth researchers defend their research and contend that critics often make "significant statistical errors" when responding to the study. They note that their conclusions would not significantly change if data were adjusted to accommodate regional cost disparities and patient health characteristics (Abelson/Harris, New York Times, 6/2).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.