To the Editor.
—The comparative study of patient outcomes by Dr Rosenthal and colleagues1 reestablishes why cost structures and pricing mechanisms in teaching hospitals may be justifiable and signals institutional providers everywhere that a nonprice basis for competition has already emerged.2 That is, the price of managed care contracts matters, but so does the documented quality of care—something consumers and their employers have sought for a long time.It is well past the time for individual physicians, physician group practices, and advanced practice nurses to track patient outcomes for the purposes of quality improvement and for competitive positioning of their practices on a nonprice (quality-of-care) basis.2 Consumers and their representatives, especially large employers, have demanded this information for years.The fact that better data on which to base managed care negotiations are lacking is unfortunate and, I hope, time limited. As Dr Iezzoni cautions,3 "Mortality rates are, at best, a blunt instrument for comparing hospital quality."
Schultz MA. Mortality and Length of Stay in Teaching vs Nonteaching Hospitals. JAMA. 1997;278(23):2062–2063. doi:10.1001/jama.1997.03550230038022
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