Just OK Quality or “The Best”?

The folks at the Oklahoma Hospital Association might want to get together with the Commonwealth Fund to see if they can borrow a URL for their hospital quality Web site.

Using the two-letter abbreviation for the state name, the Oklahoma association’s just-launched site providing quality and safety information on 80 local hospitals promises “OKHospitalQuality.” On the other hand, the Commonwealth Fund’s almost-as-new site displaying quality information on hospitals nationwide boldly asks “WhyNotTheBest?

In both cases, however, visitors will largely see repackaged HospitalCompare measures from CMS and the standardized H-CAHPS patient satisfaction survey from AHRQ. The Oklahoma association claims its site is easier to use than that of CMS, and they’re right. For instance, it’s simple to look at state benchmarks and multiple hospitals at the same time.

You might wonder why a trade group from a state whose entire population amounts to about 10 percent the number of Medicare beneficiaries does a better job of making data accessible to consumers than CMS. You might also wonder whether the CMS site’s failings affect its ability to pull visitors. While I can’t speak to the first question, Quantcast figures show that HospitalCompare draws a little under 42,500 people each month, down from about 208,000 in mid-September, when the site was being advertised. WhyNotTheBest is too new for Quantcast to have much information, but HealthGrades draws about 2.3 million individuals a month. A little math shows us that at this rate, it will take four and one quarter years for HospitalCompare to draw as many visitors in total as HealthGrades does in one month.

In addition, HealthGrades visitors are most likely to also visit physicianreports.com, vitals.com or checkmd.com, which are also rating sites. HospitalCompare’s top-ranked correlation is with ipro.gov — the people who designed the WhyNotTheBest site which is based on data from HospitalCompare. Maybe they could just Facebook each other?

Oh, yes: while WhyNotTheBest makes it easy to compare an individual hospital to a long list of benchmarks, and it has a sleek and modern design, you can’t compare two hospitals to each other on the same screen. To be fair, I believe that’s because that the site is not designed for persnickety patients, despite its catchy name. Instead, the purpose is to make it easy for individual hospitals to assess their own performance as a prelude to improving  it. Having worked with IPRO in the past, they have a great database for doing just that.On the other hand, perhaps a consumer who finds out her preferred hospital is NOT the “best” will decide just not to have any medical care at all. Or, for “OK” care, go to Oklahoma.

(PS: Meanwhile, rating individual practitioners remains a tricky business. The San Francisco Chronicle recently reported the second libel suit filed by a provider against a patient for posting a negative review on Yelp. The cases, from a chiropractor and pediatric dentist, were both “settled,” the newspaper said.

Of course, the entry of Zagat into the doctor-rating business offers intriguing other possibilities, as this satire, “Enjoy the ‘sassy receptionists’ and ‘dog-eared Hustlers…” suggestively suggests.)

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6 replies »

  1. Michael,
    I loved the title and the hint at average versus best resources!
    Doctor and Hospital reviews have been discussed and criticized in many outlets not excluding the latest satire that you mentioned.
    We, at HealthWorldWeb, believe it is about an ability to filter and deliver information that is most relevant to YOU, the patient.
    The acceptance of user-generated comments, ratings and reviews of medical professionals is catching on in our social e-healthy world, facilitated and fostered by Health 2.0 Community. However, we observe that trust has to be earned and there is too much noise, irrelevant information or subjective emotions in user’s feedback that sometimes turn people away from that right resource. That same noise creates annoyance and distrust of doctors and therefore renders the otherwise useful information into ineffective bag of words at best.
    We do believe that solving this fundamental problem will give the review process buy in from providers, reviewers and readers. For example, our doctor search has ability to deliver the results by the relevancy to the patient weather presenting a review from YOUR local community or people like YOU based on YOUR preferences.
    As far as the critics – to paraphrase Seth Godin: “if we were not doing something right, there would not be any critics”.
    We believe in personalized content and in providing the RIGHT resource (doctor, clinical trial) for the RIGHT person (mid-thirties, russsian, type 2 diabetes) at the RIGHT time (gained 30 pounds) and RECOMMENDED by people like YOU.
    Eugene Borukhovich
    Chief Evangelist

  2. Shoshanna, you raise a good question: why does HealthGrades get so many more visitors than HospitalCompare. I think you’re correct that it’s because of promotion, but the context is the magnitude. HealthGrades constantly promotes, via Google-sense ads, via press releases to the trade and mainstream media, via the ads taken out by hospitals touting their ratings and via search engine maximization. And they’ve done this for many years, acting as if their economic future depends on it (which it does). The government promotes its site kind of the way you see those “stop smoking” public service announcements.
    More broadly, HealthGrades catches consumer attention because it provides outcome information for specific medical problems. Until recently, CMS data was all wonky process stuff. And, even now, as I noted, the site is not all that consumer friendly.
    On the other hand, CMS does achieve an implicit goal — not getting any hospitals so angry that some Congressman or Senator starts endangering its funding. So, you see, CMS employees also act as if their jobs depended on what they do.
    Meanwhile, Jon, thanks for clarifying what checkMD does. Space concerns, and the focus of my post, prevented going into any detail on any of the other sites mentioned. Thanks for following up.

  3. Michael. Nice piece with some good information presented. Thank you.
    I’d like to point out that checkMD.com is not simply a “ratings site.” In fact, doctors, hospitals and pharmacies can create their own “professional pages,” which they can use as mini-web sites that can feature everything from patient forms and general information to Web 2.0 functions like video, live chat, podcasts, blogs and forums. checkMD.com is also a social community where healthcare consumers, doctors, hospitals, pharmacies, associations etc. can all interact with each other freely, providing greater transparency to the entire healthcare system. This type of interaction builds trust between patient and provider and provides the neutral ground needed to work together to improve healthcare – one patient at a time. This is what is meant by “People Healing Healthcare.”
    That said, shrinking budgets and emerging technology are making it more difficult for government organizations, professional medical organizations and trade associations to build and maintain their own “rating sites,” particularly when private enterprise sites can generate much more traffic. Perhaps trade organizations and government sites should partner with and encourage the utilization of credible, private enterprise sites that are not only aligned with their goals and objectives, but that are already doing what they aim to do. These partnerships will save tremendous amounts of time, money and resources which can assuredly be allocated towards other member/consumer benefits.
    In today’s economy and considering the emerging world of online healthcare, it makes sense for all of us to leverage existing resources to accomplish our collective objective; which is better health.
    Finally, the process of rating doctors and hospitals will always have proponents and opponents. The so-called “vocal minority” on the Internet are generally consumers with an axe to grind. This is why most doctors call physician rating sites “basher sites.” Since the vast majority of physicians are providing excellent quality care, we should all be encouraging healthcare consumers to recommend doctors and hospitals that are doing good, thereby focusing on what’s working and not wasting their energy on what’s not working in the system. Although Internet “ratings” in general (whether electronics, automobiles or doctors) tend to be fairly accurate in volume, our advantage at checkMD is that those ratings (recommendations) sit right next to the “disciplinary actions/citations” tab on the site. We therefore feel that the hard data adds an additional measure of objectivity to the more subjective user ratings. Additionally, many ratings websites have measures in place to make sure that reviews are legitimized – checkMD.com included.
    I appreciate this opportunity to respond to your insight.
    Thank you.
    Jon Black
    Healthcare Consumer Advocate
    CEO, checkMD.com

  4. Michael, why do you think HealthGrades gets more visitors? Is it becasue they actually promote their site?

  5. Feel free to check out the Puget Sound Health Alliance hospital compare web site and give us some feedback.I serve on their Health Information and Technology Committee and try to represent consumer needs vs providers, insurers and payers but would love to give them a broader audience and feed-back as we roll it forward. Our main report is provider quality scores based on 2 million covered lives but this is our hospital quality report
    The link on my name should take you to a sort by county.

  6. The metrics used for measuring the quality must be credible. One can create a metric that will always show great result while the reality could be different. Recent financials, the Peanut Company, etc are good examples of perceived and real performance.
    These websites while serve a great purpose. They are trusted by consumer to be credible source. This brings the burden to spend time in first making sure the variables measured are credible and so is data.
    For those who are Lean Six Sigma educated, this is what the measurement system development is all about.