OP-ED

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 Vitals.com 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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Vanity numberAgusKeith Reissaus-concerned consumerpropensityHarold D. Miller Recent comment authors
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Vanity number
Guest

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Keith Reissaus-concerned consumer
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Keith Reissaus-concerned consumer

I’m not convinced that government can effectively operate credible and independent reporting systems. Evidence of innovation is more abundant in the private sector. We have a long way to go before I trust data coming from the public sector. Thanks Michael.

propensity
Guest
propensity

“In reality, the site is confusing and unfriendly to consumers, painfully slow and, worst of all, factually unreliable.”
Just like EHRs and CPOEs which the doctors use every day. Glad you recognize IT defects and glad no patient’s life depended on that site.

Harold D. Miller
Guest

You don’t need Medicare’s Physician Compare site to find out about physician quality. Far better information about the quality of physician practices is available in dozens of states and regions around the country through Regional Health Improvement Collaboratives. You can see examples at http://www.nrhi.org/performancemeasurement.html. The best thing that CMS could do would be to provide financial support to encourage creation of more Regional Health Improvement Collaboratives and create links to them through its website, rather than trying to create a one-size-fits-all national database/website.

Mark Spohr
Guest

One person who has done a lot of interesting work on the NPI is Fred Trotter.
http://www.fredtrotter.com/2010/06/16/npi-data-the-doctors-social-network/
He has an interesting approach to the problem that may be useful.

Barbara Duck
Guest

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… Read more »

Barbara Duck
Guest

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… Read more »

Barbara Duck
Guest

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… Read more »

Michael Millenson
Guest
Michael Millenson

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.,… Read more »

DeterminedMD
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DeterminedMD

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?

nate
Guest
nate

“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… Read more »

patient safety advocate
Guest
patient safety advocate

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.

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

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.

Agus
Guest

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… Read more »

pcp
Guest
pcp

“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.

John R. Graham
Guest

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.