Let's Keep Our Eye On the Ball

Jay Moore, for HealthLeaders Media, November 6, 2008

If you're a baseball fan in New York or Detroit, this has been an autumn of discontent. The New York Yankees, Detroit Tigers, and New York Mets spent gigantic amounts of money on player salaries—they are the top three spenders in the game, in fact—yet somehow failed to make the playoffs. Instead, they spent this fall watching the Tampa Bay Rays, with the second-lowest payroll in baseball, advance to the World Series.

The Rays' success is an example of how analyzing reams of complex data on players' performances and tendencies can improve a team tremendously at a bargain cost. Simply throwing money onto the field in the form of underachieving famous names seldom works.

Healthcare could learn something from our national pastime, according to a recent New York Times op-ed piece penned by an unlikely trio—former House Speaker Newt Gingrich, Sen. John Kerry (D-MA), and Oakland Athletics General Manager Billy Beane. The three men contend that the key to improving healthcare quality is following baseball's lead and adopting a similar evidence-based philosophy.

The authors' assessment of the state of healthcare quality is a blunt one. "Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures," Gingrich, Kerry, and Beane write. "Studies have shown that most healthcare is not based on clinical studies of what works best and what does not—be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition."

Later in the piece, the authors conclude: "To deliver better healthcare, we should learn from the successful teams that have adopted baseball's new evidence-based methods. The best way to start improving quality and lowering costs is to study the stats."

I want to believe this. It's a blueprint that works in many facets of our society. Study the information, formulate a course of action based on that information, and implement improvements. Simple.

Except that healthcare is not baseball.

Don't misunderstand—the idea that care should be based on concrete medical data is an important one. An evidence-based approach to healthcare delivery is a critical piece of the quality puzzle. And the Times piece offers a couple of examples of healthcare organizations achieving measurable success by emphasizing evidence-based care.

But upon further inspection, the healthcare-baseball analogy starts breaking down—and other issues beyond the notion of basing care delivery on data begin to emerge:

  • No matter what course of care the "evidence" dictates in a given situation, providers still must deal with a third party that often doesn't adequately compensate them for the cost of providing that care. If improving quality and cutting costs were as straightforward as studying the proper data, the industry wouldn't be in this mess.
  • And speaking of studying data . . . which data? Whose data? Studies drawing any number of conclusions about any number of topics emanate from provider organizations, pharmaceutical companies, managed care organizations, technology vendors, independent associations—you name it. All kinds of stakeholders with all kinds of agendas. All trying to demonstrate why this test or that therapy or this drug regimen is the most cost effective while delivering the best outcomes. Plenty of information is clearly less-than-objective, and I believe many caregivers can recognize that. But there's no singular All-Knowing Book of Medical Evidence.
  • Most physicians, I believe, are receptive to the possibility of medical data indicating that the way they've always practiced medicine could stand improvement in some way. But some are not. A purely evidence-based approach would not be without pushback.
  • A person's health is about more than the care provided by physicians and nurses. Environment, genetics, behaviors—all of these affect how well a patient responds to a course of treatment. The "evidence" is only part of the equation.

I know. I shouldn't be so negative. But if we don't train a critical eye on the real issues beneath the surface—and dedicate our best minds and technology and resources to resolving those issues—the ideal of better quality and lower costs will remain just that: an ideal tossed around in abstract op-ed pieces.

A little idealism is healthy. But healthcare, unfortunately, is no leisurely afternoon at the ballpark.

Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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