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Dartmouth’s Geisel School of Medicine

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Dartmouth physician sees big benefits in hospital mergers


While the conventional  and politically popular wisdom is that mergers hurt care access and price and quality competition, at least one physician leader believes that hospital mergers benefit patients.

John D. Birkmeyer, M.D., executive vice president for integrated delivery systems at Dartmouth-Hitchcock Health and a professor of surgery at Dartmouth’s Geisel School of Medicine, says the benefits come from consolidating medical records electronically and coordinating care among institutions. This,  he says, eliminates redundant costs, tests and treatments.

He also says in this Harvard Business Review piece that  merging facilities can help end  “the persistent problem of variation in healthcare practice and outcomes, particularly in surgery.” He notes recent research that shows that thousands of Americans whose surgeries are performed by low-volume surgeons and hospitals die unnecessarily every year.

He recommends that hospitals  adopt a “volume pledge,” listing 10 complex procedures “for which scientific evidence shows that surgical volume matters” as off-limits for surgeons who perform fewer than a certain number of such procedures a  year. Consolidating hospitals, he argues, makes it far easier to adopt and enforce these guidelines.

How the current merger mania of health insurers might affect his argument is not clear.




America the overdiagnosed

Here’s an interview with H. Gilbert Welch, M.D., a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth’s Geisel School of Medicine, in which he talks about  problems created by medicine’s efforts to detect disease early. His books include  Overdiagnosed: Making People Sick in Pursuit of Healthand, most recently, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care.


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