Grand Deception at Grand Junction

In a high-profile paper in the September issue of Health Affairs, Thorson and coworkers showed that the care at St. Mary’s Hospital in Grand Junction, CO was superior to that of 20 other unnamed hospitals. Grand Junction is, of course the small town in SW Colorado that became famous when President Obama visited there during the summer of 2009, and here’s what he said:

“Hello, Grand Junction! It’s great to be back in Southwest Colorado. Here in Grand Junction, you know that lowering costs is possible if you put in place smarter incentives; if you think about how to treat people, not just illnesses. That’s what the medical community in this city did; now you are getting better results while wasting less money.”

So, Grand Junction, a town of 58,000 people located  in SE Colorado, where there are virtually no blacks and fewer Native Americans but where Family Practice rules, is supposed to be the model for the nation.

It’s rather astounding that Health Affairs would have published this paper without identifying the 20 “comparison” hospitals that make Grand Junction look so good. However, it did say that they were in Colorado, New Mexico and New Jersey, and with some much appreciated help from the authors, I’ve been able to identify the actual counties where these 20 hospitals are located. It turns out that they are clustered in four regions. Here they are, along with Mesa County, where Grand Junction is located:When the top four are averaged, the good outcomes along the Jersey Shore can’t quite balance the poor outcomes among ethnic minorities in Newark and Denver and 0n Indian reservations in NW New Mexico, so the average is not good, which makes Mesa (Grand Junction) look terrific. But if only the Jersey Shore counties are compared with Mesa (Grand Junction), the Jersey Shore wins by 22 percentage points on the county health  rankings. And when Mesa (Grand Junction) is compared with the 26 counties that have been identified as its “peers” by the government’s Community Health Status Indicators (CHSI) Web site, Mesa (Grand Junction) is dead average – identical in outcomes to its peers, none of which have Family Practice-dominated health care.

Let’s be honest, folks. Lake Wo-be-Junction is like lots of other places with few ethnic minorities and not much poverty. So let’s end the Grand Deception about Grand Junction and recognize that the major reason that communities vary in health care outcomes is that they vary in socioeconomic status. The failure to address this head is what led to the vodoo economics of health care reform, which already have cost the President a loss at the polls and are costing poor Americans a lot more.


  1. Glenn Laffel, MD, PhD

    The President’s rhetoric cited in your article is unfortunate, and the apparent oversights in the Health Affairs article are glaring and, frankly, hard to believe. Leaving those matters aside for a moment, I still think that the Affordable Care Act is a right-minded piece of legislation. It’s going to allow 32 million Americans access to health insurance for the first time. Those particularly affected are poor folks, who as you point out have worse medical outcomes. At least we can hope that when these folks are covered, they can access preventive services, health and wellness programs, get their medications paid for and so on…and hopefully this translates to improved health outcomes for these folks.

    • buzcooper

      I agree that insuring more low income individuals was important, but it didn’t take the ACA to do most of that. It took raising the income threshold for Medicaid, which the ACA does but not enough. The ACA raises it to 133% of poverty. At present , WI, MN, IL, NJ and ME are at or near 200% and CT, RI, VT, NY are between 133% and 200%. By contrast, the threshold in TX, OK, LA, MS and AL is between 24% to 47% of poverty – really poor. Somehow I don’t think it’s such a big deal to ask all of the states to do less for the poor than what 40 of them are doing already, and it sure didn’t take the ACA to do it. But only the ACA could link it to arcane incentives based on voodoo geography.

      So what about Grand Junction? Colorado is at 66% of poverty for Medicaid, but expenditures in Grand Junction are even lower, among the lowest in the state. And this is not just for inpatient care but for the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program, which is the child health component of Medicaid. It’s required in every state and is designed to improve the health of low-income children by financing appropriate and necessary pediatric services. Spending on EPSDT in Grand Junction 60% below the Colorado state average. And spending on Fedeerally-Qualified Health Centers is zero – they don’t have any.

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