A basic principle of health care is that everyone strongly favors transparency – for everyone but themselves.
“Sunshine is the strongest disinfectant” is the oft-used expression that supports putting information out in the open for all to see. That said, every stakeholder in health care gets a bit nervous about exposing their own data.
They are quick to cite the potential downsides – that patients will not be able to understand the limitations of the information, that risk adjustment will be inadequate to explain why their performance looks below average, that they may actually be below average.
No one gets as nervous about public reporting as my health care provider colleagues. We worry that everyone else may game the system, cherry-pick patients, or that we might lose patients if the data look less than perfect. It’s safe to say that number of physicians who hate the idea of public reporting is greater than the number who support it.
All of which makes it that much more fascinating that some provider organizations have recently begun putting all their patient experience data – including every patient comment about every doctor – on their Find-A-Doctor web sites. “Every” actually does mean every – the good, bad, and ugly (after removal of those that might violate patient confidentiality). And they are tied directly to the physician who delivered their care.
Why would they do this? The initial response from some commentators was that they were trying to “out-Yelp Yelp” – that is, control the information that was appearing about them on the Web. In truth, the initial idea was less about controlling information than providing more of it.
Rather than living with on-line comments generated by a small subset of patients motivated by who-knows-what to write in, organizations like the University of Utah decided that they would survey all patients electronically, and post all their comments.
And they would take the chance that more data would provide a better sense of the truth.
The University of Utah health care system was the first in the country to go down this road, and they were rewarded for their creativity and courage with a very pleasant surprise. The result over the last few years has been astounding improvement in their patients’ experience with their physicians.
The American Medical Association (AMA) says the number one issue with recent data releases from HHS is that “there is currently no mechanism for physicians and other providers to review and correct their information.”
We think we have a way to fix that problem over at the DocGraph project!
Over the last two years there have been three major breakthroughs in the analysis of doctors using Open Data. The first was the original teaming and referral database obtained by DocGraph (us) under a FOIA request. The second was the prescribing data set obtained by ProPublica. Both DocGraph and Propublica worked around the 1978 injunction limiting the use of FOIA for doctor data.
The third is the new procedure pattern data set announced as the direct result of the overturning of the 1978 injunction.
We are happy to announce the release of the first “all-in-one” open doctor data browser that we are calling DocGraph Omni. We have created a public tool that allows you to browse the merger of all three major new open data sets about doctors and other healthcare providers that bill Medicare.
Now in one place you can view how a provider prescribes, how they collaborate, and which procedures they work with. Our intention to turn Omni into a browser where you can find any open data about doctors, no matter what the source.
But this is not just about “finding” the data. We have created a system that allows anyone to comment on any given data point in these data sets.
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.
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…
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…
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.
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).
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.
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?”
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?