Evidence-based medicine succeeds in Green Bay

A triumph for evidence-based medicine in Green Bay:

In the final two years of a patient’s life, for example, they found that Medicare spent an average of $46,412 per beneficiary nationwide, with the typical patient spending 19.6 days in the hospital, including 5.1 in the intensive-care unit. Green Bay patients cost $33,334 with 14.1 days in the hospital and just 2.1 days in the ICU, while in Miami and Los Angeles, the average cost of care exceeded $71,000, and total hospitalization was about 28 days with 12 in the ICU.

Some differences can be explained by big-city prices, acknowledged Elliott Fisher, principal investigator for the Dartmouth Atlas Project, “but the differences that are really important are due to the differences in utilization rates.”

Much of the evidence suggests that the more doctors, more drugs, more tests and more therapies given to patients, the worse they fare — and the unhappier they become, said Donald Berwick, president of the independent research group Institute of Quality Improvement.

One lesson:  numbers matter.  Tired N=1 arguments and “personal stories” don’t get to overall health, no matter how tragic and unfair they are (and I’m looking at you here, Michael Moore).  What is tragic and unfair is an overall system in which people who become ill through no fault of their own use emergency rooms as primary care facilities, which paradoxically adds to the cost burden of people who do not want to pay for comprehensive health services.  Indirect costs can easily exceed the modicum of investment that such a plan would require.

I’m not sure why people who cry “socialism” at the thought of ensuring a basic level of health in the most powerful nation in the world seem not to be bothered by a “socialist” education system that attempts the same for education.  Perhaps the message would be more palatable if stated in economic or national security advantages.

So, good for Green Bay.

3 responses to “Evidence-based medicine succeeds in Green Bay

  1. Sean Safford

    I kept reading the article to find out *how* they pulled off the feat of getting their costs so low. I guess the answer is simply medical records? Even so, there is a lot of persuading that has to go on. This is a v e r y t o u c h y s u b j e c t… I suspect its partly cultural; an acceptance that the end is nearing and that a less invasive course of treatment is the right way to go. And, doctors have to know they wont be sued to within an inch of their lives if they do. The article shied away from a lot of those kinds of questions (in fact, it was surprisingly rah rah)

    • Heh… Good points all. I think that info must be out there, but I don’t know how to go about getting it. As a researcher, I’m not surprised at your interest in greater detail. Alas, the paper of record in DC is only likely to give you the slightest taste.

      All that said, I like the numbers. There has to be some downside, but again I am not quite sure what it is. Agreed that it is a very touchy subject, ranging from privacy to politics to pharma, HMOs, and all sorts of other parties trying to preserve or grab advantage… to doctors refusing to adopt technology to distrustful patients to data ownership and maintenance issues… It’s a bloody mess, one your book could probably shed some light on. (note to other readers: Sean’s book Why the Garden Club Couldn’t Save Youngstown is available wherever fine books are sold.)

      As a trans-organizational change effort, the task is colossal and perhaps fated to some unacceptable compromise. Parties’ reasons to resist are strong, and the “what’s in it for me” is really light at the moment. All that said, portable, life-long medical records and assurances that I wouldn’t be left to die in the street after being hit by a bus… well, all that sounds pretty good. Saving a bunch of money in the bargain? Great.

      One more thing: I wrote a chapter some years back on IT project failure (as defined by requirements, schedule, and budget). The average failure rate at the time was around 70%, with failure getting more likely with larger and longer projects.

  2. Pingback: Week in Public Organizations, 15Jun2009 « PublicOrgTheory

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