First, "The Cost Conundrum." Now what?

By now, someone has probably urged you to read Atul Gawande's New Yorker article on the overuse of care in McAllen, Texas. It's a jaw-dropping piece, truly astounding for what it reveals about what's driving up U.S. health care costs.

The article got noticed in high places. Peter Orszag, director of the White House Office of Management and Budget, blogged about it and concluded:

[I]n looking at an example like McAllen, Texas – a town where Medicare care costs have risen disproportionately relative to national and local benchmarks, and very quickly – it is hard not to ask what our return is on this high-taxpayer investment. From what we can measure, it’s not better health. It is simply more care.

Upon reading Gawande's article, I remember thinking, "Things must be feeling grim over in McAllen today." I felt a little sorry for them. McAllen happens to be among the most expensive health care markets in the U.S., and it's easy (and of course, instructive) to point the finger at wasteful practices there. But I wondered: do articles like this actually prompt other hospital chiefs to examine their own spending? Or does everyone shake their head at the sad state of affairs in McAllen and then continue doing things exactly the same way they've always been done?

Today I came across a really interesting blog post that (in part) answered this question for me. The post describes a memo that an unnamed hospitalist physician sent his residents, using Dartmouth Atlas data to compare the cost of care at their hospital to that of two others. The comparison, let us say, was not favorable. Here's how the physician ended his memo:

We are at the top 1% in terms of cost intensity and we use a hell of a lot of specialists...

Bottom line: When it is time for hospitals to take a haircut, even taking into account higher spending in our area -- and this is a reality as well -- we are still inefficient by the gobful. Trust me, people that matter are watching and they know we can do a lot better. Something to keep in mind as we think about how to practice sensibly. More does not equal better and it is only a matter of time before we are requested to step up and get out our `A' game. The folks who will be asking, by the way, won't be bringing cookies.

Here's what I take away from all this:

1. That is one awesome teacher. All teachers should be that honest with their students.

2. Local health care spending (whether it's especially high or especially low) is about to come under some serious scrutiny. From people like Peter Orszag, and people like Orszag's boss.

3. The people doing the scrutinizing will be relying in part on the Dartmouth Atlas of Health Care, which '"documents glaring variations in how medical resources are distributed and used in the United States."

Anyone can use the Dartmouth Atlas to look up how their state, town, or hospital is doing when it comes to using care efficiently. Is your hospital a big spender? And if so, who's working on fixing that? Go find out. Because people are going to be asking about it, and they won't be bringing cookies.