All Providers Are Not Equal

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Giving consumers information and data on providers’ quality of care and clinical results is one important path to enhanced transparency, patient engagement, and better health care.     

Two publications out this month add significantly to the dialogue on this issue.  The journal Health Affairs devotes most of its April issue to the theme of “patients’ and consumers’ use of evidence to inform health care decisions.”  And the cover story in the May issue of Consumer Reports is entitled What You Don’t Know About Your Doctor Could Hurt You.  Accompanying that story online is Consumer Reports’ latest ratings of doctors in six states and two metro areas.  

(Disclaimer:  I contributed an article to the April issue of Health Affairs and was involved in one element of the Consumer Reports piece.) 

Among observations in the Health Affairs papers: 

Star-based provider ratings, summarized information (instead of details) and well known signifiers of quality such as blue ribbons work best to compel consumers to both pay attention and make wise choices among health plans and providers.

Getting consumers to consider quality and cost (and the concept of value) remains a challenge.  A survey of some 2,000 people found that most don’t think cost and quality of care are necessarily related.   That’s good and bad.  Good because previously published research indicated that most people leaned to believing that higher price means better quality.   Bad because the new survey signals that people are still disconnected from pursuing value in health care by consciously choosing lower-cost/high-quality providers.   

A focus group analysis involving some 900 consumers found that they don’t believe scientific evidence that a treatment does not work  should necessarily trump a doctor’s decision to recommend or use that treatment.  In short, most people will defer to their doc’s judgment.  However, most people said they would pay closer attention to the evidence if it indicated possible harm from the treatment.   

Yelp reviews of hospitals by consumers track closely with reviews from patients as assessed by the more elaborate and costly Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).   Moreover, the researchers conclude that the Yelp reviews allowed consumers to raise issues that clearly seemed more salient to them (the consumers) than the HCAHPS. 

Web sites that allow consumers to review hospitals and doctors have far more traffic than sites presenting provider ratings based on quality metrics and patient experience as assessed by the CAHPS tools.  For example, Healthgrades had about 8 million unique visitors per month in late 2015.  By comparison, the California Health Care Foundation’s provider rating site CalQualityCare.org had 174,000 unique visitors in the year Oct. 2014 to Oct. 2015.   This is from my article in the journal  And one of my central conclusions: we need to leverage the popularity of consumer review sites such as Yelp and Healthgrades to bring awareness and traffic to sites based on quality metrics, in part by melding the two approaches over time.    

 Price comparison tools are still a work on progress.  One study, for example, found that just 3.5% of Aetna enrollees who had access to a price comparison tool used it. 

Consumer Reports has a different take on physician quality of care, and consumers’ right to know.  Its’ article probes the failure of government and the profession itself to stop bad or troubled doctors from practicing medicine, even after they’ve been caught. 

It’s a penetrating and sobering account.  In one case, a California ob-gyn named Leonard Kurian was found culpable after removing the wrong diseased ovary from a 37-year-old woman.  In addition, the California Medical Board found that Kurian likely contributed to the deaths of two young mothers who had recently given birth to healthy babies.  The Board cited 40 other instances of negligence and incompetence, according to the Consumer Reports article.   

Was his license revoked or suspended?  No.  The board placed him on probation from 2015 until 2022, and allowed him to keep practicing on the condition that he completes courses in clinical training, ethics, and medical record-keeping.

In the fall of 2015, Consumer Reports’ advocacy wing petitioned the California Medical Board to require doctors like Kurian to tell patients of their status.  The board rejected the idea, saying it would put too much of a burden on doctors and damage the doctor-patient relationship.   Consumer Reports obtained California’s database of doctors on probation as of September 2015.  That information is now searchable on Consumer Reports’ Safe Patient Project website.     

Enhanced scrutiny of physician quality of care, clinical outcomes, and behavior is coming.  It’s been building for years, and now, under the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), Medicare reimbursement will be much more tightly tied to quality and performance measures starting in 2019.   Consumers will play a role in that as patient’s experience becomes part of every doctor’s rating. 

Also, the Affordable Care Act mandated Physician Compare, a website now under development that will eventually present physician ratings based on the MACRA measurement scheme.   

Even so, as the Health Affairs papers and Consumers Reports article underscore, it remains a challenge to nurture full transparency in health care and present meaningful data to consumers—information they can understand and base their choices on.  Both must become a bigger priority in the years to come.

Steven Findlay is an independent health care journalist and a contributing editor for Consumer Reports.

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9 replies »

  1. If anyone need a dermatologist then we are provide the best Dermatologist who is specialist on skin care some of people warn the doctors before getting any treatment so our dermatologist first of all guide you properly.

  2. @StevenFindlay. I am having difficulty finding an online rating website for independent health care journalists so I am going to rate you right here. Mr. Findlay comes off as insensitive and accusatory. Portraying physicians as disheveled alcoholics is dangerous for patients and doctors. Placing their ratings next to other ratings of inanimate objects such as washers and dryers is of poor taste. Good job on pointing out the obvious fact that all providers are not equal. Neither are all journalists. 2 out of 5 stars.

  3. A quick update: CMS issued proposed rules for MACRA on April 27–900 pages! Comments are due June 27. They appear to have changed things up a bit in response to hundreds of comments from stakeholders last fall. We can expect another large batch of lively comments this time. They will be publicly available. Final rules for measurement year 1 (2017) will be issued later this year. Payment adjustments based on 2017 quality reporting will be made, for the first time, in 2019.

  4. Thanks for the comments. Margalit, I find your comments about Consumer Reports’ motives harsh, inaccurate, and sort of silly. CR has no intention of “destroying small practices.” Its’ physician ratings to date are produced in collaboration with state-based non-profit groups. Those groups operate with integrity and the ratings are driven by carefully thought-out methodological and practical considerations. You can read all about it on the CR site and the sites of the groups it works with. Moreover, alleging that CR is out to “corporatize medicine” is to grossly misunderstand that organization. All that said, it is indeed hard to collect meaningful data on individual docs and small groups–a challenge this field faces and must meet in the years ahead.

  5. Thanks for highlighting that not all doctors are equal…a good article.

    One root cause of gross variation in care, one that almost no one even attempts to measure, is the ability of doctors to diagnose and treat patients with complex health problems. The misdiagnoses rate on such “outliers” is about 20% and the rate of treatment errors, significant errors that can impact the points prognosis, is roughly 40%.

    Again, no doctor rating system in existence makes any effort to measure that kind of gross variation on any scale.

    The biggest quality failure is to misdiagnose a patient. When that happens everything that follows harms to patient.

  6. First, it is hard to collect meaningful data on individuals and small groups. One bad outcome can change things a lot, and not be very meaningful. Consumer Reports might be trying to sway us, but I can’t tell.

    Second, I doubt this changes consumers, dare I say patients, behavior. Heaven knows our marketing department has tried everything. We cost less, have lower mortality numbers and lower complication rates that our major competitor. However, theirs is a newer and prettier facility. Market shares just aren’t changing in our area despite making our better numbers known. To be fair, our competitor is actually pretty good, our numbers are just better. Anyway, I think geography, habit, referral patterns and other factors matter a lot more to most people. They may say otherwise, but when they vote with their feet, they don’t necessarily shop for the best facility.

  7. It’s kind of like Walmart coming in and wiping out the Mom and Pop stores that have good relationships and customer service. Except the prices and savings most certainly won’t be any better.

  8. Let’s be crystal clear about what Consumer Reports is doing here. Consumer Reports is not including in its ratings small independent practices by design. Consumer Reports is trying to limit the universe of consumer choices to large medical groups and integrated health systems. Consumer Reports is acting on behalf of corporate medicine with an implicit and sometimes brazenly explicit goal of destroying small practices, which have been shown to be better, better liked, and more cost effective than the revenue driven entities Consumer Reports is promoting. Consumer Reports is acting with complete disregard for the well-being of “consumers” in order to promote the corporatization of medicine which is an integral component of the cynically named “Affordable” Care Act.
    And now Consumer Reports is resorting to sensationalist headlines, contrived pictures and lurid anecdotes to destroy doctors in general.
    I would not be surprised if the next step for Consumer Reports is to “rate” political candidates…. on behalf of the same moneyed interests its doctors ratings are serving.