Jeff Sapp: After reading the study by Jean Mitchell, PhD, I applaud the quick response by the ASCAC, but would like to provide a better argument to suggest that researchers need to do a better job in their studies when they step into my world, the ASC industry.
First, Mitchell was involved in a mixed methodology study in 1991 that provided the first research in joint ventures among healthcare providers in Florida. The State of Florida Health Care Cost Containment Board (1991) interviewed industry leaders, surveyed providers and examined comprehensive data of specific health services of all payors in Florida to determine the effects of joint ventures on the issues of costs, access and quality. A panel of experts, including this researcher, provided oversight for this landmark study on joint ventures in Florida. The conclusion from this mixed methodology study comparing joint-ventured and non-joint-ventured ASCs indicated that joint-venture multispecialty surgical facilities treat no Medicaid patients, but are similar in comparison to non-joint-ventured surgical centers relative to cost, charges, quality and profitability. Surprisingly, this study is never mentioned in any literature review from current research studies (not even Mitchell’s).
Secondly, the continued use of quantitative studies versus qualitative or mixed method approaches is a major point of contention. As seen in Mitchell’s research study, this quantitative approach attempts to emphasize the importance of measurement and analysis of causal relationships between variable, not processes, within a value free framework. Mitchell’s quantitative study fails to support the notion that knowledge derived from social investigation would eventually result in the same mastery over the social world that physical science achieved for the physical world (Smith, 1983). The quantitative method through analytical reality is supposed to be independent of its observers, objective as well as invariant or unchanging to environmental fluctuations. The desire for volume-based results is directly associated with the attempt to develop new laws against physician ownership in the ASC sector.
Third, supporting my argument, Mills (1959) seminal work was a call to arms from his belief that research in social science (now healthcare) suffered from two significant problems: a blind obeisance to the grand theory and an overreliance on abstracted empiricism as a research technique. Mills (1959) stressed that any systematic attempt to understand involves an alteration between empirical and theoretical assimilation, concepts and ideas grounded in factual investigation, and detailed investigations to check and reshape ideas. Mitchell’s study supports Mills assertion that the abstracted use of quantitative analysis resulted in trivial work that lacked any connection to the social structure. The concrete reality of people and things to which we can relate with the reality of our wonders, is replaced by abstractions, by ghosts that embody different quantities, but not different qualities (Long, White, Friedman & Brazel, 2000).
In summary, Mitchell needs to revisit the seminal work of Mills that emphasized the needs to get down to the facts, but not get overwhelmed by them; to anchor ideas in facts, but not sink to the ideas. The reality of healthcare is far too complex to permit the establishment of causal laws from inadequate, biased quantitative studies and only supports the notion that this is nothing more than an attempt to influence a political agenda. We can no longer sit on the sidelines and allow this to happen to physician ownership in ASCs.
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References
Long, R. G., White, M. C., Friedman, W. H., & Brazeal, D. V. (2000). The qualitative versus quantitative research debate: A question of metaphorical assumptions? International Journal of Value-Based Management, 13, 189-197.
Mills, C.W (1959). The Sociological Imagination. New York: Oxford University Press.
Smith, J. K. (1983). Quantitative versus qualitative research: An attempt to clarify the issue. Educational Researcher, 12, 6-13.
State of Florida Health Care Cost Containment Board. (1991). Joint ventures among health care providers in Florida (vol. II). (Agency for Health Care Administration, 2727 Mahan Dr., Tallahassee, FL 32308)
