Resisting evidence when it doesn't jibe with our personal or institutional wishes

Former US Senator David Durenberger (R-MN), in his monthly commentary from the National Institute of Health Policy at the University of St. Thomas, writes about an example of a patient and a provider balking at evidence and outcomes data.

The commentary is built on the back of a story in the St. Paul Pioneer Press by Jeremy Olson (who is leaving soon to join the Star Tribune across the metro). Durenberger writes:

For many years MN health insurance companies like BCBSMN have been trying to convince members that they can provide more value for the premium prices they charge, because they can give members access to higher value health care services. This is what the HMO has been about for three decades and “data on docs” and the creation and sponsorship of the Institute for Clinical Systems Improvement (ICSI). For example, Health Partners Medical Group reports key clinical outcomes of more than 400,000 patients classified, since 2004, by socio-economic status, race and ethnic group because more than 90% of their patients will trust them with that kind of information.

Jeremy Olson, St Paul Pioneer Press, writes about an interesting new chapter in this effort. A 38-year-old leukemia patient is concerned that BCBSMN requires her to go to the Mayo Clinic for a bone marrow transplant rather than to the University of Minnesota where she has received all her care. “It breaks my heart,” the patient says. But BCBSMN has the local and national data to show that Mayo’s transplant outcomes for cases like hers are better than the UMN. The response from UMN is: “We treat the toughest cases that others won’t.” This is the kind of response we’ve become used to hearing when outcomes research is used to inform and to direct pre-paid patient decisions.

It doesn’t hold water. When lives are at stake, and reputations are on the line, research data must be as precise as possible. There are those in the medical industry who love bashing insurers and managed care even more than President Obama does. Traditional insurance plans will tell you that hospitals with less than the best outcomes may be motivated by their finances in taking on cases for which success is less likely. I will always recall the two neurosurgeons involved in the development of the cyber-knife telling me about a Miami colleague who bought two and was making a mint off “hopeless” tumor cases.

When the UMN says their cancer transplant cases are “tougher” than Mayo’s and therefore their success rate is lower, they need to be asked first to prove it, and then whether admission decisions can be affected by reimbursement which is unrelated to outcomes. What I would love to know, were I this patient, is which cancer centers, or which oncological surgeons, in this country have even better results for people like me than Mayo. Maybe one is right here in Minneapolis?

This gap – between what evidence shows on outcomes – and individual or institutional resistance to the evidence – is a huge barrier standing in the way of any meaningful health care reform.

Kudos to Jeremy Olson and David Durenberger for writing about it.

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Comments (4)

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Karen Runyon

July 9, 2010 at 7:34 pm

Gary, check out the book Better, the chapter concerning cystic fibrosis treatment. Data collected demonstrated that the greatest survival rates in the nation, and sufficiently better than any other center, were at UM. The writer explores why. It is a thoughtful exercise by all medical centers involved. Very admirable.

Cal Lutrin, MD

July 18, 2010 at 7:35 pm

There is a rumor making the rounds in Phoenix about the Mayo Clinic’s desire to maintain good outcome statistics by refusing to treat some patients with advanced, i.e. risky, disease. I do not have any factual data, although a friend of mine who has severe congenital heart disease and has an LVAD told me that he was not be accepted by the Arizona Mayo Clinic for this very reason. He had to go the U of Arizona in Tucson for the LVAD which has turned his life around, even though he had been treated at Mayo and they have a heart transplant program. Unfortunately the transplant surgeon at U of A, Dr Copeland, has left and the transplant option is not available to my friend at this time.