Historically, the physician has been viewed as the leader of medicine, with responsibility for the care and outcomes of patients; in iconic photographs and paintings, the physician is seen as a lone, heroic figure. Such a view has led to natural interest in the measurement of individual physicians’ performance. It is therefore not surprising that some information brokers, including the U.S. News and World Report and many city magazines like the Washingtonian, provide ratings of “top doctors,” often based mostly on reputation, warranted or not.
However, this focus on the individual is flawed for most measures of quality and presents substantial technical challenges. Systems-based care is emerging as a key value within health care and a vital component of high-quality care, while the notion that an individual health professional can be held accountable for the outcomes of patients in isolation from other health professionals and their work environment is becoming an outdated perspective. For example, better intensive care unit staffing sometimes mitigates the evidence that surgeons who perform more procedures achieve better outcomes .
The communication and coordination of services across providers is required to ensure that patients, many of whom have multiple conditions, are assisted through various health care settings . For some aspects of care, such as diagnosis errors and patient experience, measuring at the individual physician level might be considered. Nevertheless, focusing measurement on an individual runs counter to our goals in promoting teamwork and “systemness” as core health care delivery attributes.
Continue reading “3. Measure quality at the level of the organization, rather than the clinician.”
Filed Under: Uncategorized
Tagged: ACOs, Featured Posts, Harlan Krumholz, Peter Pronovost, Physician Ratings, Physicians, Robert Berenson, RWJF
May 26, 2013
What happens when consumers are able to compare the performance of primary care physicians in their state using Consumer Reports, the magazine that’s so highly regarded for its ratings of thousands of products and services we all use every day? Well, for the first time ever, we’re about to find out.
A special Massachusetts version of July’s Consumer Reports magazine will feature a report entitled “How Does Your Doctor Compare?” along with a 24-page insert that includes ratings of nearly 500 primary care physician practices from across the state. The ratings are based on data from a comprehensive patient experience survey conducted by Massachusetts Health Quality Partners (MHQP), a coalition of consumers, physicians, hospitals, insurers, employers, government agencies, and researchers. The physician ratings report is also available online at www.mhqp.org.
In recent years, there’s been a lot of talk in the health care community about the importance of consumer empowerment and patient-centered care. This experimental collaboration between MHQP and Consumer Reports, funded by the Robert Wood Johnson Foundation’s Aligning Forces for Quality program, helps move theory into practice, and will test some key assumptions about the value of transparency in the effort to improve the health care system. In many respects, ratings of primary care physicians are not new to Massachusetts. We at MHQP have been reporting the results of patient surveys and clinical quality data since 2006 and these reports have had a positive effect on health care in our state. But let’s face it, Consumer Reports adds a whole new dimension to the notion of transparency. Not surprisingly, their involvement has been met with both excitement and some trepidation in the physician community. Continue reading “Patient Power”
Filed Under: THCB, The Business of Health Care
Tagged: Consumer Reports, Empowerment, Health Outcomes, MHQP, Patient-centered care, patient-doctor communication, Physician Ratings, primary care, RWJF, Transparency
Jun 7, 2012
My in-laws are in town for my daughter’s graduation.
When I came home yesterday I was greeted with a big smile and vigorous handshake from my father-in-law. ”I just want to thank you,” he said, standing up from his chair, “for finding us a good doctor. The one you found for us is wonderful.”
My wife smiled at me warmly. I just earned myself big points. Yay!
Her parents and mine are both in their 80′s and are overall in remarkably good health. When I called my father after he had a minor surgery over the summer, my mother told me he had a ladder and was “on a bee hunt.” It’s a blessing to have them around, especially having them healthy.
My parents have a wonderful primary care physician, which takes a whole lot of pressure off of me to do family doctoring, and puts my mind at ease. I’ve only personally contacted him once when my dad had a prolonged time of vague fatigue and body aches. I try not to use the “I’m a doctor, so I am second-guessing you” card that I’ve had some patients’ children pull. I called his doctor more as a son who wanted a clear story about what was going on than as a physician with thoughts on the situation.
“I first want to say that I am very grateful my parents have gotten such good care from you,” I said at the start of the conversation. ”It’s nice to not have to wonder if they are getting good care.” Continue reading “Finding a Good Doctor – A Doctor’s Notes”
Filed Under: Uncategorized
Tagged: elderly care, good doctor, Google, PCP, personal recommendations, Physician Ratings, polymyalgia rheumatica, primary care, Rob Lamberts
Jun 7, 2012
If you want to let others say who you are, don’t dive into social media. If you are too shy about the prospect, then don’t complain when surveys like this are published:
Cardiologists, for the most part, drive Japanese cars, believe in a higher power, and are moderately savvy when it comes to social media. Those are just some of the pearls from a lifestyle survey of physicians conducted by Medscape and published online today.
Asked to rank their level of happiness outside of their work on a scale of 1 to 5, the 762 cardiologists who replied to the survey provided an average happiness score of 3.92. That puts them 15th out of the 25 specialties surveyed, where rheumatologists, dermatologists, and urologists were the happiest, with scores of 4.04 to 4.09, and neurologists were, it seems, the glummest about their nonworking lives, with scores of 3.88.
Continue reading “The Risk of Avoiding Social Media: Others Get to Say Who You Are”
Filed Under: Physicians, THCB
Tagged: Physician Ratings, Social Media, WebMD
Mar 25, 2012
These days, I’d never consider trying a new restaurant or hotel without reading the on-line ratings on TripAdvisor or Yelp. I seldom even bother with professional restaurant or travel critics.
Until recently, there was little patient-generated information about doctors, practices or hospitals to help inform patient decisions. But that is rapidly changing, and the results may be every bit as transformative as they have been in traditionally consumer-centric industries like hospitality. Medicine has never thought much of the wisdom of crowds, but the times, as the song goes, they are a-changin’.
Even if one embraces the value of listening to the patient, several questions arise. Should we care about the patient’s voice because of its inherent value, or because it can tell us something important about other dimensions of quality? How best should patient judgments be collected and disseminated – through formal surveys or that electronic scrum known as the Internet? And what are some of the unanticipated or negative consequences of measuring patient satisfaction and experience? All of these questions are being debated actively, and some newly published data adds to the mix.
For the past few years, Medicare has been administering the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey to a random sample of 300-1000 patients discharged from every U.S. hospital. Results are now posted on Medicare’s Hospital Compare website. Starting in late 2012, hospital payments will be on the line, as part of Medicare’s pay-for-performance program, known as “Value-based Purchasing” (VBP).
Continue reading “The Patient Will Rate You Now”
Filed Under: Physicians, THCB
Tagged: Hospital Compare, Physician Ratings, Value-based Purchasing, Yelp
Mar 19, 2012
You can’t get much cooler than HealthTap: slick Silicon Valley start-up, social media darling, savvy and successful backers. But when you closely examine the service HealthTap actually provides, the money and good looks fall away. Like in the fable about “the emperor’s new clothes,” behind the buzz, there’s nothing there.
OK, maybe one thing: a really risky way to get medical advice.
Here’s how a Feb. 4 New York Times article described the company’s website:
[U]sers post questions and doctors post brief answers. The service is free, and the doctors aren’t paid. Instead, they engage in gamelike competitions, earning points and climbing numbered levels. They can also receive nonmonetary awards — many of them whimsically named, like the “It’s Not Brain Surgery” prize, earned for answering 21 questions at the site.
Fellow physicians can show that they concur with the advice offered by clicking “Agree,” and users can show their appreciation with a “Thank” button.
So far, so good. But there’s more. The professional credentials of the physician answering your question, such as a board-certified specialty, are not available on the site. Instead, you get a crowdsourced “reputation level” built up by accumulating HealthTap awards, by clicks of approval from other doctors and by other measurable activities at the site.
Continue reading “The Emperor’s New Social Network”
Filed Under: Health 2.0, THCB
Tagged: Healthtap, Michael Millenson, Physician Ratings, Ron Gutman, Social Media, Startups
Feb 9, 2012
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?”
Continue reading “Fixing The Failure At Physician Compare”
Filed Under: OP-ED, Physicians
Tagged: Medicare, Patients, Physician Compare, Physician Ratings
Apr 28, 2011
Congressman Paul Ryan (R-WI) and Alice Rivlin, former director of the Congressional Budget Office (CBO), have proposed an entitlement spending reform plan that is striking both for its boldness and its left-right-coming-together origins. There are a number of interesting parts, but I want to focus on the three most important:
- Medicare would, for the first time, be transformed into rational insurance. Beginning in 2013, all enrollees would be protected by a $6,000 cap on out-of-pocket expenses; in return they would pay for more small expenses on their own.
- After a decade, people newly eligible for Medicare would receive a voucher to purchase private insurance instead. The value of the voucher would grow at the rate of growth of GDP plus 1% (note: for the past four decades, health care spending per capita nationwide has been growing at about GDP growth plus 2%).
- Medicaid would be turned into annual block grants to the states. The value of the block grants would also grow at GDP growth plus 1%.
Bottom line verdict: This is a good proposal that deserves serious attention. To guarantee its success, however, more needs to be done to (1) allow the private sector to control costs through economic incentives, competition and entrepreneurship and (2) allow young people to save for the growing share of expenses they will be expected to bear.
How Does This Plan Compare with the Affordable Care Act (ACA)? Given that Ryan has been previously attacked by Paul Krugman and others on the left because of his ideas about voucherizing Medicare, a natural question arises. How does the Ryan/Rivlin slowdown in Medicare spending compare to the health reform bill Congress passed last spring — a bill supported by some of the very people attacking Ryan?
Continue reading “The Ryan/Rivlin Plan”
Filed Under: Uncategorized
Tagged: CMS, Costs, Health Care Reform, Medicaid, Medicare, Physician Ratings, The ACA
Nov 29, 2010
A study by the Center for Studying Health System Change that will be released today shows that hospitals receive different prices for treating the same diseases. Center President Paul Ginsburg says this about the findings:
“The variation in hospital prices found in this study are (sic) inconsistent with highly competitive markets—at least for markets outside of health care,” said HSC President Paul B. Ginsburg, Ph.D.,
Hospital markets may not be highly competitive, but this argument is silly. One might as well say “The variation in automobile prices is (not “are”) inconsistent with highly competitive markets.” But one would be wrong in either case.
Vertical quality differentiation (i.e., some sellers are better than others) generates price dispersion in competitive markets. It is only in the most basic treatment of competition — in the first week of an intro economics course — that vertical differentiation is ignored. Observed price dispersion is not incompatible with competition. Continue reading “Hospital Price Dispersion”
Filed Under: Uncategorized
Tagged: CMS, Medicare, Physician Ratings
Nov 18, 2010
Let’s say you’ve enrolled in a new health insurance plan and need to find an internist who participates. How do you decide which doctor to choose? My (long deceased) grandmother made her choices by using the following criteria: She looked for a male doctor with a Jewish-sounding last name who graduated from an American medical school—preferably one located in New York City. Nowadays her narrow (and culturally biased) criteria would have excluded some of the most esteemed practitioners around.
If you are like most people, you don’t depend on your grandmother’s advice to find a physician, but rather ask friends, colleagues or other doctors for recommendations. But taking one person’s experience with an internist or surgeon as a signal that he or she is “really good” is still far from the optimal way to choose a practitioner.
Over the years, several commercial websites like HealthGrades and Angie’s List have cropped up that provide such consumer-friendly information as the distance a doctor’s office is from the patient, and whether foreign languages are spoken there. They usually include ratings that reflect consumers’ personal experiences with the practitioner. For people who want to dig deeper, most state medical boards collect data that can be searched to find out where your doctor went to medical school, where he did his residency and what board certifications she has. In some states you can also search to see if the doctor in question has received disciplinary action or been sued for malpractice.
This is a lot of on-line legwork for the average person—a task that even professionals can find difficult. Chip Amoe, assistant director for federal affairs at the American Society of Anesthesiologists told a group recently, “When I tried to go find a primary care physician, I couldn’t. You know, it was very difficult. I had to go on several different Web sites to be able to find [one].”
Continue reading “Rating the Raters: Physician Compare”
Filed Under: Physicians
Tagged: CMS, Medicare, Physician Ratings, primary care
Nov 18, 2010