What gets measured

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By Merilee Dannemann

By the sheerest coincidence, I have just read two books that turned out to share a theme: the power of statistics. “Moneyball,” by Michael Lewis, is about major league baseball.  

“Mountains Beyond Mountains,” by Tracy Kidder, is about the physician Paul Farmer, who revolutionized medical care in rural parts of Haiti and other remote places.

Both books describe revolutions in the practice of a discipline because of a revolution in what gets measured and somebody’s bull-headed insistence that it is critical to measure the right things.

Which brings me to the New Mexico workers’ compensation system, which I happen to know rather well, and what isn’t measured.

The New Mexico work comp system measures cost but not results. Therefore, we don’t know what works and what doesn’t.

Workers’ compensation provides medical care and monetary benefits to people who get injured at work. But we don’t know how many injured workers get better and how many just get stuck.  

Work comp is primarily run by private insurance, mandatory for most employers and very different from other types of insurance. The law is filled with complex details about exactly how claims are to be managed and how benefits are to be calculated. Many of these provisions were enacted in a major reform of the New Mexico law in 1990.

The reform was driven primarily by a crisis in the cost of insurance, which was so high it was damaging the state’s economy and job creation. The success of the reform was also measured by cost.  

Work comp is so complicated — and so different from other systems — that it’s dangerous to say anything about it in this brief format, because almost any statement will be correct in some cases and incorrect in others, or true but incomplete and therefore misleading. So this article is an oversimplification.  

According to the New Mexico Workers’ Compensation Administration’s latest published annual report (2008), the cost of premiums for the sector of employers covered by conventional insurance was about $263 million (this excludes employers in self-insurance or group programs).

What did they get for their money?

We might hope they would get good outcomes for their injured employees: workers who received adequate and compassionate medical care, recovered from their injuries fully, or as much as medically possible, and got on with their lives — whether or not they returned to work with their pre-injury employer. Outcome factors are subjective and therefore very hard to measure. But not impossible.  

And we might want to know how those outcomes were affected — if affected at all — by specific provisions in the state’s law, so that we could know which provisions to change.

In baseball, what is traditionally called an “error” could be a fielder’s clumsy failure to catch the ball, or a fielder’s heroic but failed attempt to make an impossible play. According to Lewis, some diehard baseball fanatics figured out how to make that distinction for every play in every game in major league baseball and to rate players’ competency on this basis.

Both Lewis’s and Kidder’s books make the point that, before their respective revolutions, what was measured was often not what was most important but what was easiest to measure.

Work comp is not a ball game, and I doubt there are any fanatical statisticians of workers’ compensation outcomes. But there could be and should be — especially since in this political season there is new talk about the need to revisit the law.

It would be helpful to know what we are doing on the basis of reality.

Merilee Dannemann is a syndicated columnist with the New Mexico News Service.