VAMs in U.S. Healthcare: A Parody

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Remember the AZ teacher who has written some great posts for us at VAMboozled (see here and here)? She’s at it again. Read this one for an (unfortunately) humorous parody on the topic of VAMs and how they might also be used to evaluate America’s doctors.

We have a real problem in this country. People are dying. They are dying from heart and blood pressure related illnesses. They are dying from diabetes. In 2010, close to 70,000 people in the U.S. died from diabetes. For heart and blood-pressure related illnesses, the news is even worse: over 700,000 people died. Healthcare in this country is going down the tubes. And when you compare American healthcare with the healthcare in countries like Finland or other some Asian countries, the problem is made even clearer.

How did things get so out of control? And what can be done to fix the problem?

The answer lies in the research: doctors. Research has shown that a doctor’s intervention is the single most important factor in whether a patient lives or dies. Additionally, the research has shown that the quality of a doctor impacts patients’ health outcomes. The solution to our healthcare woes, then, is our doctors. Imagine a country where we have a high-quality doctor in each and every doctor’s office and hospital!

But how might we do this? And how might we ensure that every patient in the United States has access to a high-quality doctor?

Fortunately, we need not look far. The United States education system has, for some time now, been “successfully” using an evaluation system to ensure that every student in America has a high-quality teacher. A new system would not need to be created, then—it could simply be modeled after the existing teacher evaluation system as based on VAMs!

This is how it would work. Upon a patient’s initial visit to a doctor’s office, the patient would be pre-tested. This pretest would be comprised of standard blood work (lipid profile, glucose, etc…) and a check of blood pressure. After nine months, the patient would be post-tested. The post-test would be comprised of, again, the same standard blood work and a check of blood pressure. The results of the pre- and post- tests would then be plugged into a sophisticated formula that controls for most of those factors not within the doctor’s immediate control (ex. patient diet, number of office visits, type of insurance plan, exercise, etc…). The result would then accurately indicate how much “value” the doctor “added” to the patient’s health.

Then, once we know which doctors are adding to patient health and which are not, insurance companies, hospitals, and medical practices could decide to which doctors they want to offer monetary bonuses, contracts, and special certifications, or rather renege on contracts and certifications in the inverse. Additionally, doctors might receive labels (highly-effective, effective, developing, or ineffective) that could be housed in state databases and perhaps advertised in searchable data-sets on line, to both streamline the vetting process for those (insurance companies, hospitals, and/or medical practices) who are interested in offering a doctor employment as well as members of the public so that they too might have access to “the best” information about doctors’ quality of care.

The only real problem here would be that only about 30% of the doctors would be eligible for ratings as the tests used are not “standard” across all doctors and all patients, depending on their needs and conditions. But these other tests shouldn’t count anyway as they are not standardized and accordingly more subjective. 

Not to fret, however, as statisticians could use the actual scores for the eligible 30% to make hospital-level value-added assertions about the others for whom these standardized data were not available. Because the value-added ineligible doctors ultimately contribute to the effects of the value-added eligible doctors, even though the ineligible may never come into contact with the eligible doctors’ patients, the ineligible are still contributing to the community’s overall effects.

Hence, implementing a value-added based evaluation system to hold doctors accountable for their effectiveness might just be the key to solving our health problem in the U.S. High-quality doctors will become more high-quality if held accountable for their performance, and THIS will better ensure the health and well-being of our nation.


1 thought on “VAMs in U.S. Healthcare: A Parody

  1. It is worth stressing to readers that VAMs are used in many other areas including for doctors as this post discusses. For example, Goldstein and Spiegelhalter (1996) discuss use in New York of VAMs of individual doctors (Table 2, p. 402) and much on the league tables for hospitals. This discussion on VAMs (or as often referred to outside of the US on league tables) is available at:

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