There is an excellent article in the October 6, 2015 issue of the Journal of the American Medical Association (JAMA) by Dr. Aria Razmaria and Dr. Edward Livingston entitled, “How to Use Online Clinician Rating Systems.”
The article describes three high-profile doctor quality rating resources:
The article states that Medicare’s Physician Compare may be the most accurate resource because it uses data that is provided by the doctors themselves. However, Physician Compare only indicates 1) if the doctor participates in a quality measuring program within Medicare called Physician Quality Reporting System (PQRS), 2) if the doctor uses electronic health records or 3) if the doctor uses electronic prescribing to pharmacies. Physician Compare DOES NOT indicate how well the doctor did in PQRS or what their ‘score is.’
Physician Compare also has general information like practice location, hospital admitting privileges, board certification, etc.
In my opinion, Physician Compare does not answer the questions, “Is this a high quality doctor?” or “How does this doctor’s quality compare to other doctors?”
The JAMA article then goes on to list 6 Reasons why Consumers’ Checkbook’s Surgeon Ratings and Propublica’s Surgeon Scorecard are of Limited Utility:
- The Medicare data used to rate the doctors is 1-2 years old and therefore, out-of-date.
- The metrics (i.e. scores) that they use are not ‘Universally Accepted’ in the medical community.
- The Medicare data is intended for billing purposes, not for measuring quality and therefore, does not include important clinical information necessary to accurately rate quality.
- The organizations that publish these doctor quality ratings are private and not held publicly accountable if they make errors.
- The surgery complications used to rate the particular doctors may have been caused by another covering physician or healthcare provider such as a nurse or other hospital employee.
- The quality ratings were not ‘fully risk adjusted.’ Risk-Adjusted means that doctors who take care of ‘sicker’ patients that are more prone to complications are not penalized, i.e. their complication rate is ‘adjusted’ for the ‘risk’ they take in caring for sicker patients.
The article then goes on to suggest 6 questions a person could ask to assess doctor quality as an alternative to these rating systems:
“How necessary is the treatment that is recommended for me? What are the alternatives to the proposed treatment? What are the clinician’s and hospital’s experience and expertise in providing the proposed treatment? How often do they perform the treatment? How are complications monitored, and what is done to ensure the best result possible? How will I be cared for after I get the treatment?”
The subject of measuring physician quality is highly controversial. JAMA and the physicians that wrote the article DO NOT think these quality rating systems are valid. Other highly respected physicians such as Dr. Ashish Jha from Harvard DO think the Propublica rating system is valid. Dr. Jha has a very well written blog on this topic entitled, Misunderstanding Propublica.
What does this mean for employee benefits professionals and healthcare consumers:
— Measuring doctor quality is a work in process. Caveat Emptor—Buyer Beware. Proceed with caution.
— Potentially look at any discussion around doctor quality as having ‘two sides to the story.’ If a person says ‘X is a good measure of physician quality,’ potentially question that. If another person says ‘X is a bad measure of physician quality,’ potentially question that too. In many cases the answer is ‘we just don’t know,’ which is not ideal, but better to know that you don’t know than to live in a delusion.
Finally, I will add that at Compass we report on quality with 1) patient ratings (what did patients think of the doctor), 2) process measurements such as 24/7 call-in access or on-site diabetes educators/nutritionists and 3) volume of certain surgical procedures performed.
These measures are not perfect either, but like other organizations, we work to improve our methodology every day.
To learn how Compass works with over 2,000 employers to provide the quality information above along with In-Network Allowed Amount Price-Transparency (i.e. the ‘real cost’), visit compassphs.com