Fixing The Failure At Physician Compare

Fixing The Failure At Physician Compare


The launch of Medicare’s Physician Compare website at year-end should have been a watershed event in the long campaign for health care transparency and patient empowerment. Instead – and it pains me to write this – Physician Compare is a case study in how the interests of the average citizen can be shunted aside by indifferent government, lazy journalists and solipsistic special interests. That remains true despite all of those involved being Good People Trying To Do The Right Thing.

In reality, the site is confusing and unfriendly to consumers, painfully slow and, worst of all, factually unreliable. Put bluntly, the agency, whose leader famously called himself a “patient-centered … extremist” in a 2009 Health Affairs article, has produced a consumer tool that practically shouts, “We couldn’t care less whether any consumer ever uses this.”

Fortunately for CMS, most of the journalists writing about the site apparently did little more than cut and paste the government press release description of it into their own stories. If I were a federal flack, I’d drink a toast to that famous Marx Brothers movie line: “Who are you going to believe, me or your own eyes?”

The most notable exception was Forbes’ David Whelan. In a biting critique, he wrote that the site “is little more than a directory of doctors and one that, in my basic testing, is missing many entries and slow to load. You’d be better off using a site like HealthGrades or for research since those sites actually list where the doctors trained and in some cases provide richer information like patient reviews, which hospitals the doctors practice at and how good they are, and even malpractice or disciplinary records.”

As for the additional quality information the site pledged to provide, Whelan says he had difficulty finding it or even understanding what it meant.  Me, too – and both of us are far more sophisticated users than the average patient.

My experience in getting the site to do the basics it promised was even worse than Whelan’s. After typing in my suburb’s zip code, I’d sometimes receive a list of internists practicing here and sometimes be told there were none. I’d ask for doctors within a one-mile radius and get back a list of more than 500 providers within 15 miles. The site couldn’t even reliably supply physician addresses on the same page as their names. Sometimes it did. Sometimes it didn’t.

CMS did not respond to Whelan about site usability and clarity, but the agency did say it will “begin to implement” in 2012 a plan for making available more comprehensive quality and patient experience data. This information will start appearing by Jan. 1, 2013. Both dates are required by statute. I’ll tell my 89-year-old father to mark his calendar.

Perversely, Physician Compare’s ineffectuality probably protects it from provider ire. Based on past experience in places like the state of New York, a tool that prompts patients to start differentiating among doctors based on clinical criteria could create a political firestorm the Medicare agency is ill-equipped to handle. As it is, physician groups want the government to let doctors correct information. And, in regard to such clinical outcome rankings, these groups also want to ensure there is “adequate” adjustment for patients’ medical conditions before treatment (otherwise known as, the my-patients-are-sicker factor).

Meanwhile, future-focused consumer advocates seem to be giving CMS a free pass on its current failure to provide a basic, reliable and usable tool. In a Perspective piece for the California HealthCare Foundation, David Lansky of the Pacific Business Group on Health and Steven Findlay of Consumers Union gloss over the present in favor of a detailed blueprint showing how Physician Compare could be a “game changer for consumers” if only the government “is bold, decisive and innovative.”

But are those hopes realistic? The health law notwithstanding, the Physician Compare experience suggests the public might be better served in some instances if government provides data while the private sector analyzes it and presents it electronically. “Private sector” is a term that also includes non-profits. After all, as the leader of the Foundation for Accountability, Lansky pushed the envelope on transparency. Findlay has helped do the same at Consumers Union. Depending on the political views of the president appointing the CMS director in 2013, I might prefer a Lansky or Findlay exercising more control over health care information than the U.S. government.

As government regulators, journalists and consumer advocates are fond of reminding doctors and hospitals in a different context, good intentions don’t excuse bad results. In a recent survey, two-thirds of adults said they’d like access to more comprehensive information about doctors. Medicare should fix Physician Compare today and learn from its mistakes to make systematic improvements for tomorrow.

Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of
Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the
Information Age”.

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23 Comments on "Fixing The Failure At Physician Compare"

Jan 28, 2011

Here here Michael – spot on as usual. This first attempt is painful in that rather than being clearly a first step in a difficult but necessary path, it will be seen as further bumbling and ineptitude which will threaten the credibility of the site from here on. Especially considering the dismal history of PQRI which could have provided a strong foundation, but has been so poorly implemented and essentially gives more ammunition to those standing in the way of transparency. While it is easy to blame the government, I place some accountability on the physicians themselves, who have resisted and obfuscated just about every attempt to be measured, along with their resistance to adoption of electronic systems which more widely used would facilitate these efforts. Of course one of those things may have something to do with the other…

Jan 28, 2011

If I could “adopt” an electronic system, I might be interested. But I have little interest in paying through the nose for something that slows me down (look at the new growth industry of EMR scribes) and does not improve patient care (see Ann. Int. Med.)

Robert Oshel
Jan 28, 2011

One thing that could be done quickly — if Congress would only change the law — is to open the National Practitioner Data Bank so consumers could find malpractice payment history, serious peer review actions, and licensure sanctions against physicians, dentists, and other health care practitioners.
The information is comprehensive and has been reported for over 20 years — since 1990. It is also reliable since it is reported only by the entities that made the payments or took the actions, practitioners can add their own comments to reports, and they can have erroneous report corrected or removed.
Currently the NPDB is not public because of a provision in the Health Care Quality Act of 1986. Congress needs to change that.
Robert E. Oshel, PhD
RETIRED Associate Director for Research and Disputes
National Practitioner Data Bank
Note: my comments are my own and do not represent the opinion or policy of my pre-retirement employer, the US Department of Health and Human Services.

Jan 28, 2011

If all of this is true, the site should be taken down. It is a travesty, misleading, inaccurate and a threat to public health. This is what we get when we have governmental interference. CMS originally was a payment entity. Their role has been totally distorted.

Kerry O'Connell
Jan 28, 2011

As a payment enity CMS should withold payment from whatever vendor they hired to build this website, it simply does not work.

Stephen Motew, MD, FACS
Jan 28, 2011

Excellent post with disappointing information. I too am aghast at the woefully inadequate database query site. Does the failure of such a relatively ‘simple’ project portend the ability of CMS/HHS/Berwick etc to tackle the really difficult mandates in the ACA…I fear so.

Jan 28, 2011

Thank you for this. However, this outcome is not “despite” “Good People Trying To Do The Right Thing” but because of “Good People Trying To Do The Right Thing”.
From James Madison to Friedrich von Hayek, we’ve been warned that the well-meaning folks are more dangerous than the evil-doers, because a democracy is more likely to surrender individual sovereignty to such folks.
Imagine if the government had not wasted money on this effort, and the people who produced it had done so in the private sector. Surely, they would have created a more valuable tool.

Jan 28, 2011

“The launch of Medicare’s Physician Compare website at year-end should have been a watershed event in the long campaign for health care transparency and patient empowerment”
Unrealistic expectations for a website, to begin with.

Craig "Quack" Vickstrom, M.D.
Jan 28, 2011

Anybody can publish anything they want on the net. It was designed that way. If you consume information from the net the same way you consume information from National Geographic, you will look like an idiot. So you have to be careful what you what you believe. It’s that simple.

Mar 7, 2012

Doctors make too much money, period. They are just ogirfled technicians. They do not do anything creative. They just follow instruction books. Yes it is complex but so are many other things. I would not have such an attitude if I received true care from a doctor. Instead they are generally too self-important to be bothered to really care about patients. Most doctors seem to have gone into the field simply because of the money. I see very few who truly care about their patients. Instead they drive around in their BMWs and Mercedes to flaunt the money we put into their pockets. I have three college degrees, two in science, and an MBA. I know about going to school. We all work hard. I was accepted to medical school myself but chose a different path. I did not start out feeling this way but our system is broken. We must go to socialiized medicine. As a young man I was against this. I am generally a free market kinda guy. However, healthcare is different. A person should not be relegated to second class citizen because he/she has a health problem. Currently if you have a health issue and lose insurance coverage you are out in the cold. The insurance company/physician/drug company raquet needs to be totally smashed. Basic healthcare in a developed nation like ours should be a given. We should not be forced to spend so much of our resources to line the pockets of medical professionals. It is just like paying airline pilots exhorbitant salaries to be glorified bus drivers. Physicians are public servants. They do not grow the economy. They should be paid well for their expertise but these specialty salaries of $250K to $500K are rediculous. I know that we have the best healthcare system because we pay more for it. However, only the truly wealthy can afford to take full advantage of it. While other nations don’t have as great a system at the very high end, at least their typical citizens can afford to access it. I have generally made from $150K to $200K in sararies and bonus myself, so I am not a poor person. But even I consider it a luxury to keep my family in the type of healthcare services that they need. Something is wrong when I have worked this hard and still feel that I am always just on the edge of not being able to provide adequate healthcare for my family. One misfortune and I am just another poor slob that loses all access to the healthcare system. My father was a blue collar worker and died of cancer. In his final days he was shuffled around by physicians who tried to get rid of him because he was not able to keep up with his bills and doctors did not want to stoop to taking patients on government health plans. Screw the doctors! It is time to take our healthcare system back! I am pissed off and my votes will certainly be going toward a more just healthcare system.

patient safety advocate
Jan 28, 2011

Maybe we should send a link to this post to Don Berwick along with the accumulating comments with a cover e-mail that reads: SUGGESTION BOX.
I respect Dr. Berwick and would bet that he’d welcome this critique.
He has done wonders for leading hospital improvements and saving precious lives.

Jan 28, 2011

“the public might be better served in some instances if government provides data while the private sector analyzes it and presents it electronically.”
Wonder of a FOIA request could get someone the database?
pcp why don’t you think the expectations could have been higher in this case? What they were trying to accomplish has already been done by numerouse other sites. Those sites main shortcommings are;
small data sets
lack of funding/profit potential(who pays for it)
legal exposure for disclosing provider data providers dont want public
They didn’t have to worry about any of these. All they had to do was copy the best features out of existing sites, throw it on top of their HUGE database and they should have had a very successful product.
At this point they should do the tax payors a favor and just give the data to existing sites or the public domain and let them deliver on the promise.

Jan 28, 2011

Reading this post makes me wonder if the AMA is involved somehow in this chicanery. I mean, this organization supports the PPACA, so I would be interested if someone could research if the AMA is involved with the CMS Organization. Maybe a red herring, but, if no one asks the question, does the answer fall out from the sky spontaneously?

Michael Millenson
Jan 28, 2011

What is most distressing here is that Medicare allowed a subcontractor (presumably) to design a site that just doesn’t work in either a data retrieval or plain-sense communication manner. If this is what happens with the simplest of data, what happens when the data become more complicated to display and more difficult to verify?
I don’t think the AMA is involved at all. And while I have no problem with the fact that insurers and web entrepreneurs do a better job, there is data that only the government will have the political nerve to put out for the public (i.e., data that really, really angers some doctors), and so the private sector getting it right is no excuse for the government not to.

Jan 29, 2011

Did anyone read my response to David Whelan at Forbes? I’m all for correct data and being I wrote an EMR year back kind of get the drift on this stuff with consulting with MDs.
Anyway, a lot of the data is flawed and myself and some MDs did some homework here as we wanted to see the real story. If you go back to my September article of last year where I found my deceased former MD doctor on HealthGrades, Vitals and so on still listed as practicing and taking HealthNet.
I’ll provide some links for the history here but they were not upgrading their data base, flawed with many errors and on top of that a private equity firm, Vestar about six months ago paid big buck for HealthGrades.
The AMA and myself had a nice little interview and talk about this which was also published on their website too.
There are lots of dead doctors, retired doctors, doctors connected with hospitals they have never set foot in and it was on 8-10 sites where many appear to be drinking the same data base Kool Aid. Here’s the original article and I might also add you might want to think about not believing everything 100% you see on the web.
So moving along another company says they have a good MD referral site, AVVO, who does the same for lawyers, same dead doctors, mistakes and more.
In talking with one MD, he found Healthgrades had an executive of an IPA, who had never been a doctor listed, so again if you are an MD, then I would check out your listing.
The data for the commercial folks comes from insurance companies and state medical boards, and also there are those who commit fraud and find out who is not updated and can find a dead doctor NPI and find holes to send fraudulent claims, so they mine the web too.
So in doing my comparison, I also looked at the commercial compared to CMS and wrote about the fact that again we find some of the same dead doctors and numerous other flaws. Healthgrades admittedly so said they have dead doctors listed and are working to improve their system and what all of these folks need to at least remove the dead doctors is to use the social security death index, so in this instance the best source for flaws with dead doctors is a government data base. Is anyone doing this, doesn’t look like it.
Now in following this along with some input from doctors who looked at their own areas, yes CMS had some missing data but you can read the comments by one MD which I put on the post, he said in his area unlike Healthgrades, AVVO and Vitals, there were no dead doctors but he found other items missing and that seemed more of the case of missing data with his comments on the CMS site, it was less flawed but lacked some detailed information.
I might also add I had a reader comment on the fact that they enrolled for the additional information from Healthgrades for a monthly fee and they said they are having one heck of a time getting that monthly charge off their credit card as it did not appear to be working for them or was a service they felt they did not need.
Getting back to my case with my former doctor of 8 years still being listed, the widower of my deceased former doctor had tried several times to have her removed to no avail and for 8 years had to leave the message of disconnect on the former office phone number that it had been disconnected too, phone company could not even re-use that number for 8 years.
Again, I’m all for accurate and truthful data but before making an opinion on some of this, what I always say is there’s nothing like first hand information and go look for yourself first and see what you come up with as again with opinions today every thing might not be 100% fact. I work with data bases so perhaps I might zero in faster when I see signs of something not being correct.
One final item here is you may want to look at the Dow Jones lawsuit against CMS too and if you are a doctor, take at a look at what I had to say here as the Dow Jones and WSJ seem to think any old company could take this information and put it out there in a format for average readers to see on what Medicare has paid doctors over the years, and we all know there will be tons of errors with the billing data base? If you are an MD, do you want to see this out there, mistakes and all?
Give it some thought as I said if companies like Healthgrades supply such flawed information and if they were given the contract (and it would make $ for the PE too) as an example, would you trust that information and what are the unintentional consequences of this data being out there to only confuse consumers more.
Myself I think it would be a huge distraction and show MDs in an even less favorable manner and sure law enforcement should have access themselves, but what is this going to prove? Sure there could be information on Dr. Justice as an example who is still listed all over the place on currently seeing Medicare patients on Healthgrades, CMS and pretty much all of them, even though his sentencing for Medicare fraud comes up in February and this was the second time he was caught.
CMS said they are working on round 2 and we can watch and see if they get their data work better with the update but again for now, if you think the commercial sites are doing a better job, well look again. I have a few more articles on this topic but these are the meat and potatoes here on this topic of MD referral sites.