In a high-profile paper in the September issue of Health Affairs, Thorson and coworkers showed that the care at St. Mary’s Hospital in Grand Junction, CO was superior to that of 20 other unnamed hospitals. Grand Junction is, of course the smal town in SW Colorado that became famous when President Obama visited there during the health care reform debates during the summer of 2009, and here’s what he said:
“Hello, Grand Junction! It’s great to be back in Southwest Colorado. Here in Grand Junction, you know that lowering costs is possible if you put in place smarter incentives; if you think about how to treat people, not just illnesses. That’s what the medical community in this city did; now you are getting better results while wasting less money.”
So, Grand Junction, a town of 58,000 people located in SE Colorado, where there are virtually no blacks and fewer Native Americans but where family practice rules, is supposed to be the model for the nation.
It’s rather astounding that Health Affairs would have published this paper without identifying the 20 “comparison” hospitals that make Grand Junction look so good. However, it did say they were in Colorado, New Mexico and New Jersey, and with some much appreciated help from the authors, I’ve been able to identify the actual counties where these 20 hospitals are located. It turns out that they are clustered in four regions. Here they are, along with Mesa County, where Grand Junction is located:
When the top four are averaged, the good outcomes along the Jersey Shore can’t quite balance the poor outcomes among the ethnic minorities in Newark and Denver and 0n the Indian reservations in NW New Mexico, so the average is not good, which makes Mesa (Grand Junction) look terrific. But if only the Jersey Shore counties are compared to Mesa (Grand Junction), the Jersey Shore wins by 22 percentage points on the county health rankings. And when Mesa (Grand Junction) is compared to 26 counties that have been identified as its “peers” by the government’s Community Health Status Indicators (CHSI) website, Mesa (Grand Junction) is dead average — identical in outcomes to its peers, none of which have family practice-dominated healthcare.
Let’s be honest, folks. Lake Wo-be-Junction is like lots of other places with few ethnic minorities and not much poverty. So let’s end the Grand Deception about Grand Junction and recognize that the major reason that communities vary in healthcare outcomes is that they vary in p-o-v-e-r-t-y. The failure to address this head is what led to the vodoo economics of healthcare reform, which already has cost the President a loss at the polls, and it’s costing poor Americans a lot more.
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*