Dartmouth’s Elliott Fisher Argues with…Dartmouth’s Elliott Fisher
Elliott Fisher and his Dartmouth Atlas research team this afternoon released a response to this morning’s front-page New York Times article that raised several important questions about the validity of their research into health care costs. In responding to the Times’ characterization that their research does not consider spending measures that prolong life, Fisher points to a post on the Times’ blog in March, which reads in part:
End-of-life measures could penalize hospitals providing potentially costly but life-saving procedures. This is true of any cost measure, and is why we have always emphasized measuring quality, such as patient satisfaction, avoidable-readmission rates or health outcomes…The lower-cost hospital systems that are often held up as a national model, in part because of the Dartmouth data, appear to get results that are as good as — if not better than — higher-cost systems. (Emphasis added)
Compare that quote from March with Fisher’s own quote in this morning’s Times piece: “We never asserted and never claimed that we judged the quality of care at a hospital—only the cost.” So in other words, Fisher and the Dartmouth team never believed that their research would judge quality – except when they did. Got that?
In a similar vein, the researchers attack the supposed “misrepresentations” in the Times piece, but Fisher himself admitted in the same story that “he was sometimes less careful in discussing his team’s research than he should be.” So the Dartmouth response attempts to minimize the scope of Fisher’s misrepresentations, while simultaneously accusing the New York Times of multiple “factual errors.” Some might characterize an academic who admitted overstating his factual claims in a newspaper article turning around and attacking that same article for “misrepresenting” his work as indicative of no little amount of chutzpah.
But the bigger health policy question is this: How credible is research – which Donald Berwick called “the most important research of its kind in the last quarter century” – undertaken by a professor who admitted he oversold his claims? Is the Dartmouth Atlas really the “Holy Grail” of health policy – promising better care at lower costs – that Peter Orszag and others hold it out to be? Or is it, as Fisher admitted in this morning’s article, really just an examination of costs and spending – a tool that government bureaucrats can use to deny patients access to life-saving but expensive treatments?