Some Follow-Up

Remember the Atul Gawande and McAllen Texas fracas?  That New Yorker article captured the national spotlight and put a harsh glare on areas of the United States that had unexplained high rates of health care utilization.  Dr. Gawande blamed the local culture of fee-for-service private practice, while the Disease Management Care Blog wondered if it was a statistical fluke and/or the burdens of a chronically ill population. 

It turns out that there might be another factor at play.

The DMCB recently received this rather stunning (and lightly edited) email:

Here is a little story I thought I would share.  As you know, Atul Gawande wrote about McAllen TX over 3 years ago. You would think having the spotlight on them would make people scramble to clean up their act. On a recent flight, I sat next to a medical sales representative. His company has a number sales personnel covering the state of Texas, but none of them are assigned to the McAllen territory. That's because it is known that you have to “pay to play.”  In one example, a physician asked the company to send a check to his charity…so they did some research and found the address for the charity was located at a corn field.  Reportedly there are dozens of medical companies that service Texas but only 3 or 4 bother to sell in that market. Sounds like old habits die hard!