Physician Report Cards: Don’t Shoot the Messenger

There is a BIG difference between the popular consumer/physician matching Websites such as: Vitals.com, RateMDs, Angies List, Healthgrades, Zagat and UCompareHealthcare (a NYTimes property), and the other initiatives in place to monitor physician performance as driven by hospitals, government and other payers and health plans. Soon, these differences will be merging with the more complex score cards from hospitals joining forces with the consumer tools.

OPPE (Ongoing Practice Performance Evaluation) and FPPE (focused Practice Performance Evaluation) are initiatives set in place by The Joint Commission (TJC), an arm of the American Hospital Association that accredits health care organizations. These initiatives are coming main stream to provide structured and frequent review of a hospital’s physician personnel. There is nothing new about these initiatives, (TJC has always been a follower in health care business intelligence), but soon ongoing reporting will be required by all and supplied by a variety of experienced commercial firms.

Private enterprise has been helping hospitals benchmark, profile and rate physicians on a broad spectrum of metrics relevant to specific acute service lines for decades. Of course mortality, length of stay, risk-adjusted complications rates, patient safety events and indicators, patient satisfaction, and a long list of Core Process Measures have all been part of that analysis. Progressive hospitals have been sharing this information with physicians, and for the most part physicians have accepted that the profiling analytics have done a good job of educating them on their performance. Medical Evaluation Committees have their hands full with information to help credential and reappoint physicians to hospital privileges, and a more informed dialog has been fostered.

But, just like comments on this blog, sometimes it is the messenger who gets shot! I recently heard a story where a major commercial analytics firm helping a large not-for-profit hospital system fired the firm because they identified too much “opportunity for change” in the department of the hospital that sponsored that vendor! These folks will eventually figure out that firing the messenger is a short term strategy leading to non-compliance…and perhaps significant patient risk! If you have been told you are significantly below the benchmark, and you ignore the warning I suspect you are legally liable for future failures.

In the early days of physician report cards, we saw this similar behavior at the doctor-level, with all kinds of objections…The data is wrong, data is old, my patients are sicker, the methods are flawed, my patients are all high risk etc etc. All of these objections have been addressed with credible fully vetted methodology and science. Yet, we also saw physicians who simply had no idea that they were so far off the charts, and who became totally engaged in the process of improvement frequently becoming the greatest advocates for continued monitoring and improvement.

The good news is today we have the provider industry engaged and activated with defining the metrics by which a physician will be compared to their peers. We also have across the board metrics that apply to all areas of practice that are fair and reasonable for ratings. And we have organizations like the Society of Thoracic Surgeons (STS) opening up their seminal performance database from their participating physician groups. These are all great steps toward transparency, and an indication that physician report cards are here to stay.

Even so, the litigious California Medical Association (CMA) has filed a class action suit against Blue Shield for their “bogus physician rating system” know as “Blue Ribbon Recognition Program” claiming that positive recognitions will “…undercut the entire medical profession”. Wow! We will see how that plays out in the courts…but should another messenger get shot in court over CMAs own failure to provide transparency to California citizens?

Hospitals, large group practices and even sole practices are collecting standard performance measures whether it is for pay-for-performance or quality performance improvement initiatives. The next obvious step is to extract a portion of this data and promote it to consumers by merging it with the popular consumer Web sites that connect consumers with physicians. It is a self-serving function, as the overwhelming amount of data reveal, most patient experience and outcomes data is quite positive. By promoting your experience, those with the lowest scores will be revealed (and they likely won’t promote theirs) and your message gets out into your community. Become the messenger for your success and accomplishment, and be responsive to what 66% of Americans want…greater transparency about physician performance.

OPPE and FPPE will find their way into the consumer doctor-finder Web sites, and it is incumbent upon physicians to push it there sooner than later. Ultimately, the better aggregated sources end up getting licensed to health plans anyway, so join forces to aggregate data and let’s spend less time in the courts fighting the shortsightedness of a single health plan. After all, in the end what does CMA have to offer California consumers when it is all over? Physicians and their representative coalitions should become the messenger and become an advocate for improvement…then we all win.

John R. Morrow has founded, created and contributed to a variety of national and international ratings programs including; 100 Top Hospitals : Benchmarks for Success℠ a Thomson-Reuters product, The Patient Satisfaction Index™ a National Research Corporation product, The Hospital Value Index™ a Press Ganey & Associates property, and is currently in Beta with Distinguished Doctor™, a new doctor profiling initiative. Morrow was a Principal at HCIA/Solucient, CEO of CHKS (UK) Ltd, SVP at HealthGrades and is Principal at The Ratings Guy LLC. John welcomes all comments.

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