Analysis

An at least temporarily pulled study that shows the low costs of urgent care centers compared to free-standing emergency departments in Texas shed light on the infighting that can exist in the seemingly staid world of academic papers.

The conflict over the paper for the Annals of Emergency Medicine,  the journal of the official publication of the American College of Emergency Physicians, exposes the much lamented “silos” in healthcare, and interest groups trying to demonstrate the advantages of either urgent care centers or emergency departments and their impacts on patients.

Or do they?  Or does the situation show that researchers and physicians are addressing far different scenarios in a search for truth that the journal editors just feel uncomfortable about, at this point, and don’t believe is fully documented?

Those are the among the issues that are likely to be explored in the days, weeks, or months ahead in the wake of the Journal of Emergency Medicine’s decision to pull from its website the study that determined that, for instance, a patient can be charged as much as 10 times more in a free-standing emergency room than in an urgent care center for the same diagnosis.

Some emergency department officials complained about flaws of the findings, raising questions about the data. The top author, however, has said the criticism was unfounded and appeared to be political.  HealthDataBuzz revealed the removal from the website on May 8.

The complaints in question about the study centered on data about reimbursement rates paid to doctors, journal editor-in-chief  Michael  Callaham told the Houston Chronicle. Lead author Vivian Ho, a health economist at Rice University’s Baker Institute,  had said officials of the journal had complained mostly about data in an appendix in the study that was later corrected.  Retraction Watch also has reported on the controversy.

Blue Cross Blue Shield of Texas Says the Controversial Study is Right On

Recently, the paper by Ho and colleagues gained a big boost for its accuracy from Blue Cross Blue Shield of Texas, whose researchers also participated in the study.

“This important study highlights the unnecessary increase in cost associated with the use of freestanding emergency rooms, particularly at a time when healthcare costs continue to rise,” BCBS’s Chris Callahan, senior director, media and public relations, said in a statement.  “The facts remain, freestanding emergency rooms charge up to 10 times more than urgent care centers with more than 75% overlap in diagnoses.”

The statement said that the BCBS “firmly supports the work done” by Ho and other authors from Texas academic institutions in the paper.

On the surface, the BCBS statement — similar to one given and first reported by the Houston Chronicle —  appears to be a strong backing of the study. Game over. A home run. Get the study back in the journal and published, no?

Not Ready Yet

But…hold on.

The BCBS statement was immediately criticized, as a top official representing free-standing emergency departments accused Blue Cross Blue Shield of engaging in a scheme against emergency medicine doctors, the Chronicle reported.

Meanwhile, in  email exchanges with HealthDataBuzz within the past two weeks, Callaham, the journal editor, professor emeritus of emergency medicine at the University of California-San Francisco,  said that although BCBS told the press it validated the findings, it had yet to send him information “attesting to the completeness of the data.”

The journal’s editor said he wanted BCBS  to share the data or at “least provide an important third party assessment of it.”

However, Blue Cross Blue Shield of Texas said it would communicate with Ho, not the editor.  “The communication channel has been between the journal and Dr. Ho,” the BCBS spokesman said. “As lead author, it’s probably best to keep that as the primary channel.”

That disappointed Callaham, the journal editor.  Callaham said he would have liked a “specific executive to be responsible for the completeness of the data, not an anonymous” quote to the press from BCBS.

“There should be an identified individual who stands behind the data and vouches that it is accurate and complete,” Callaham said.

The data. There’s the rub.

In the meantime, Ho is planning a follow-up response, and both sides are hoping to work toward a resolution, though judging from the statements and feelings of the parties involved, it may not be an easy task.

Whatever decision is reached can be a boon for care for patients, the ultimate priority, when they figure out the numbers.

— Joe Cantlupe