What are we measuring?

So it has become apparent (to me) that our methods of measuring return on investment in health care are flawed.

Prevention’s savings are debatable. The NEJM: “Whether any preventive measure saves money or is a reasonable investment despite adding to costs depends entirely on the particular intervention and the specific population in question.” PLoS: “Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained.”

OK, but what about the individual lives saved? How about the extra years of quality living?

Value of care assessments at hospitals are numerous and have a long way to go.  Consumer Reports is trying something new according to Comarow on Quality:

Unlike the magazine’s trademark tables with little filled-in colored circles showing how well hospitals perform various procedures or deliver types of care, these rankings show how aggressively or conservatively—longer or shorter stays, more or fewer tests and specialist visits—patients are treated at a hospital relative to all other hospitals. The rankings are based on Medicare patients in the last two years of their lives who had been hospitalized any number of times during that period for any of nine chronic conditions—heart failure, dementia, and coronary artery disease are three. Adjustments were made to compensate for some patients being sicker than others.

Kaiser: “Health information technology by itself is unlikely to produce the significant cost savings projected by economic analysts and policymakers, according to a Congressional Budget Office analysis.”

OK, but what about reduced medical errors or the existence of continuity of care? Health Populi writes:

The ROI-rationale for the widespread adoption of health IT in the U.S. is a macro, national one. It’s a public health calculation that’s been mired in commercial/private health arithmetic. The denominator of these wrong-headed ROI calculations has been wrong-chosen: it’s been the individual physician practice, or the hospital, or the single health plan. The denominator is the public’s health.

As we begin to make decisions that will change our health care system, our measurement of the impact of those changes will have to evolve as well.