"How many Medicaid patients we have–that's something that can add 35%," Stewart says. "If you start risk adjusting, all of a sudden, we compare very very favorably, about the same as Grand Junction CO or Rochester MN.
"It's amazing, but though the average age of our population is young, somewhere between 26 and 28…it's a cohort that's already obese and diabetic." Stewart estimated that about 30% of the population has very little care and no resources, and 15% have not been diagnosed, although if they saw a physician, they would probably have "the triad: high cholesterol, diabetes, and hypertension."
True, Stewart says, "this is a very very peculiar and unique area that is clearly an outlier, but to say this area should look like a middle American town in Iowa – this area is never going to look like that. And to have someone parading around the White House saying this is required reading. And now, we're getting in all these blogs. Some of them want to blow up McAllen at this point."
McAllen has a lot of new medical buildings, and there are many providers who have come to the area with new technologies in recent years. There is a heart center, new imaging equipment, and a new hospital. "He cited all the high tech equipment that's available, and there has been a huge amount," says Stewart. "But most of those pieces of equipment have been here less than five years."
They could only have a minimal impact on the Dartmouth Atlas' statistics. "If you want to write an article," he says, "at least keep it in the same time period."
But many of these physicians were recruited to an area that still has an acute shortage of physicians, said to be among the lowest in the country per 100,000 people, Stewart and other McAllen physicians said.
However, Stewart says that all the attention has prompted doctors in McAllen to take a closer look at how they provide healthcare. And while Stewart believes that Gawande's piece is wrong in how much it exaggerates healthcare spending in his area, "it has drawn our attention to areas where there are duplications and inefficiencies.
"Home health, for example, we might use that too much. And we have some other issues with communication, in that one doctor who takes care of a patient has no idea what another doctor has done for that patient," says Stewart. Two hospitals in the area now have electronic medial record systems and a third is launching a more extensive one that can be accessed in physicians' offices.
"I hope Mr. Obama listens when we speak because we have some important things to say," Stewart says. "If he's actually forming policy based on this article, without knowing what we really need, I have serious concerns about healthcare reform. There are very logical and obvious reasons why this area deviates from the norm, and it doesn't have that much to do with overutilization, despite Dr. Gawande's claim."