Medical staffs can mean millions for baseball teams handling injuries

I'm shamelessly stealing the title of Po Bronson's great book to illustrate the difficulty that MLB teams have in keeping players healthy. Over the last decade, teams have spent more than a billion dollars on players that were on the DL. That's billion with a B, all spent on players shelved for injuries that could be preventable. Certainly there will always be injuries in sports -- which keeps me employed -- but there doesn't have to be quite so many and they don't have to be quite so serious.

Many will ask how I know this to be true, and I'll direct you to look at the massive gap between the best teams and the worst teams when it comes to keeping players healthy. This isn't a flukish statistic, but one based on a decade of numbers. Looking back through 2002, the gap between the best and the worst teams is almost $100 million dollars. In fact, the team that saved the most money over that time period -- the Chicago White Sox-- saved almost exactly enough money to have bought their entire 2005 roster. You might remember them as the team that won the World Series. Thanks to Herm Schneider and his staff, the Sox got that one for free. You can think of a good medical staff like a "Buy 9, get the tenth free" deal at Costco.

On the other side, there are teams that lost significantly more than expected, costing their teams as much as $30 million. My data was normalized, so don't think that giant payrolls like the Yankees skew things that much. Using my Injury Database, we took all the lost DL dollars, adjusted them to the average, and then used a percentage above average to create the rankings. Using that average, a very meaningful number encompassing over 300 team seasons, we were able to then generate the savings. Teams with larger payrolls do have more opportunity to save "real" dollars," especially with big ticket players, but this levels the playing field for that, not that it always works out that way in the real world.

In fact, it's "smaller market" teams that often lose huge dollars to poor signings like Erik Bedard or Ben Sheets. Some teams seem to "buy" injuries, taking risks on players that have known problems. The Rangers did this with Brandon Webb, who's gone from perennial Cy Young contender to missing the last two seasons due to a shoulder injury. The Rangers feel they can take this kind of risk because of their solid medical staff and the fact that team ortho Keith Meister did the surgery on Webb in the first place, giving them an information advantage. When the A's signed Sheets, they not only didn't have the information advantage, they were also handing him over to a medical staff that had its hands full with chronically injured players already on the roster. (The A's have since made a change, bringing in a new head trainer, Nick Paparesta. Paparesta comes over from the Rays, who have ranked in the top five among medical staffs over the last decade.)

A majority of teams are around average over the last decade. Many of these have major fluctuations -- a year in which they're good, followed by a year where the injuries hit more. Most around baseball would call that "part of the game" or "luck." While it's essentially random around the average for teams that allow it to be that way, the fact that some teams consistently stay at the top or the bottom suggest that there's more to it than mere randomness.

The Brewers have been second only to the White Sox in preventing injuries over the past decade, in part because they've decided that random isn't good enough. They made the unusual move of putting their medical staff under the direction of assistant GM Gord Ash. Ash has focused effort, resources and thought onto his medical staff, leading to a reduction in injuries and a better understanding of the intersections of health, performance and development. The team has used this "one page" approach, aligning the scouting, medical and minor league departments to generate results. From Roger Caplinger's major league staff down to the Single-A level, the Brewers seem not only to be able to acquire good young pitching, but to keep it healthy. The team has certainly had challenges at every level, but players such as Mark Rodgers, Manny Parra and Rickie Weeks show how well the team can limit injuries, rehab players and get the most out of their available resources.

Not every team buys into this type of program. Teams such as the Nationals, Orioles and Mets have had below average results for the studied period. (There are no accurate records of injuries before 1997.) Some teams, like the Blue Jays, show solid results, but have had difficulty over the past three years keeping pitchers healthy. In 2009, the Jays were a bit better than average overall, but broken down by pitchers and position players, there was a huge divide. The team couldn't seem to keep pitchers healthy at any level. There was no pattern. The injuries happened to different body parts. They happened at different levels. They happened to starters and relievers. They happened to American and Latin players. There was no pattern, just flukish results. The Jays stabilized to a more normal level with pitcher injuries in 2010, but while teams like the Mets improved over a horrendous '09 campaign that reached historic injury levels, they only made it back to below-average. How bad can it be? The Orioles lost over $30 million more than average over the last 10 years. The Nationals were worse, but they had that whole Montreal situation in there that I can't fairly adjust for.

What's clear is that player movement can be affected by the team context. A player moving from a weaker team to a better team in terms of medical results isn't guaranteed a change, but the data shows that his risk does go down significantly. It allows a team like the Brewers to make a deal for Shaun Marcum, knowing that even with his significant injury history, he's more likely to stay healthy in Milwaukee's rotation than in Toronto's. Interestingly, there's no clear trend to show that players or their agents have figured this out. Players with significant injury histories don't tend to move toward the better medical teams, though when they do, there's a notable increase in health over predicted levels.

For the fantasy player, health is key. I can't tell you how many fantasy teams I've had that have been crushed by injuries, and I know I'm not alone. Understanding the risks of player health won't prevent injuries from taking their toll on our teams, but we can better understand the risks and use them to value players more properly. It's one thing to buy Jose Reyes at $50 and see him lost to a series of hamstring injuries and another to find a risky player like Carlos Beltran and be able to fairly value him heading into next season. Is Tim Lincecum really a freak that can ignore workload issues or will he succumb to the kind of forces that have caused Brandon Webb, Josh Beckett and other Cy Young candidates to falter?

Fantasy players seem intensely curious about this, but teams? Not so much. No team has a research budget that reaches seven figures. MLB's research grants are going unclaimed, largely because teams don't have the proper personnel to conduct valid scientific studies. Moreover, they don't want to share any advantages they might find. The last decade has seen the smartest minds in baseball go to teams -- Keith Woolner, Sig Megdal, James Click, and Tom Tango are all doing work for teams -- and yet the most basic sabermetric principles are still ignored in favor of baseball orthodoxy. Until that changes, the next 10 years will likely look a lot like the last 10. That means lots of time lost to the DL and dollars burned on players who are sitting, not playing.

Let me give one last piece of encouragement to MLB teams to start spending on medical staffs and research: Teams that are in the top 10 over the last 10 years also won more. It's easy to see why and harder to understand why more teams aren't trying to raise that part of their game.