Num­bers to crunch

Bet­ter pub­lic data needed to help pa­tients com­pare and choose physi­cians

Modern Healthcare - - Opinion -

In the fad­ing hours of 2010, Medi­care launched Physi­cian Com­pare, a web­site re­quired by the health re­form law. The ini­tial site (medi­care.gov/find-a-doc­tor) of­fers lim­ited in­for­ma­tion for now and isn’t user-friendly. Even so, the move helps kick­start two core el­e­ments of health re­form: giv­ing con­sumers more in­for­ma­tion and rein­vent­ing the doc­tor-pa­tient re­la­tion­ship.

If all goes well, con­sumers will soon be able to rou­tinely con­sult de­tailed in­for­ma­tion on the In­ter­net about doc­tors be­fore choos­ing one. They’ll glance at the ba­sics—where the doc­tor went to school, of­fice lo­ca­tion, board cer­ti­fi­ca­tion, her re­search and who funded it. They’ll then check the rat­ings by hun­dreds (and even­tu­ally thou­sands) of a doc­tor’s pa­tients. Fi­nally, con­sumers will com­pare physi­cians’ scores on a “dash­board” of 20 or so clin­i­cal and out­comes mea­sures.

That’s the vi­sion that emerges from the three pages of the Pa­tient Pro­tec­tion and Affordable Care Act that au­tho­rize Physi­cian Com­pare. But it’s also the vi­sion em­bod­ied in other sec­tions of the law, many ini­tia­tives now un­der way, and it’s cer­tainly the vi­sion har­bored in the hearts of health­care lead­ers, pay­ers and con­sumer ac­tivists. Namely, col­lect ac­cu­rate data; give doc­tors re­li­able feed­back about their per­for­mance; re­ward those who per­form well; sen­si­tize con­sumers to vari­a­tions in the qual­ity of care; and let con­sumers choose on the ba­sis of ac­cu­rate, easy-to-un­der­stand com­par­a­tive in­for­ma­tion.

This is a vi­sion, how­ever, that gives physi­cians heart­burn, al­most as much as the man­aged-care wars of the 1990s. They bri­dle at the in­creased scrutiny and con­tentious de­bate and even lit­i­ga­tion has es­ca­lated. Af­ter com­plaints from doc­tors’ groups, in 2008, New York’s then-at­tor­ney gen­eral, Andrew Cuomo, now the state’s gov­er­nor, pressed Cigna Health­Care to stop “tier­ing” doc­tors based on fi­nan­cial met­rics alone. Cigna agreed and other in­sur­ers in New York, and then na­tion­wide, agreed to stop us­ing fi­nan­cial mea­sures alone to rate or tier doc­tors.

Since then, how­ever, state med­i­cal so­ci­eties have sued, or threat­ened to, in Mas­sachusetts, Cal­i­for­nia, Connecticut and Texas—al­leg­ing physi­cian qual­ity mea­sure­ment ini­tia­tives were based on in­ac­cu­rate or mis­lead­ing data. The Amer­i­can Med­i­cal As­so­ci­a­tion, joined by 47 state med­i­cal so­ci­eties, sent an open letter in July to the health in­surance in­dus­try al­leg- ing wide­spread “un­sci­en­tific method­olo­gies and cal­cu­la­tions” in physi­cian rat­ings. In Jan­uary, the Min­nesota Med­i­cal As­so­ci­a­tion asked the state’s sec­ond largest health plan, Med­ica, to de­lay the roll­out of a rat­ing of 9,400 doc­tors, say­ing the ini­tia­tive was un­fair to doc­tors and prone to er­rors.

Physi­cians’ groups last year also pressed the fed­eral gov­ern­ment hard to scale back the ini­tial phase of the Medi­care elec­tronic health record adop­tion pro­gram.

The ten­sion cre­ated by these push-backs stalled progress but didn’t stop it. The EHR adop­tion pro­gram launched Jan. 1, and sev­eral thou­sand doc­tors have al­ready signed up. Many in­sur­ers and em­ployer groups are pro­fil­ing doc­tors. Con­sumers Union, the pub­lisher of Con­sumer Re­ports, joined forces with the So­ci­ety of Tho­racic Sur­geons last year to post rat­ings of 221 car­diac surgery pro­grams na­tion­wide. And even the AMA-led Physi­cian Con­sor­tium for Per­for­mance Im­prove­ment has gen­er­ated dozens of qual­ity mea­sures that are in wide use.

With the fed­eral gov­ern­ment now poised to gather and pub­lish physi­cian-level data, here are some steps needed to move ahead:

Im­ple­ment mea­sures that mat­ter to con­sumers. Pa­tients need in­for­ma­tion and data on doc­tors that is un­der­stand­able and ac­tion­able. The Na­tional Qual­ity Fo­rum, the mul­ti­stake­holder en­tity that en­dorses mea­sures, must move faster to ap­prove new ones that mat­ter to peo­ple, not just health­care ex­perts.

Stan­dard­ize mea­sures and col­lec­tion meth­ods. To­day, it’s pos­si­ble for a physi­cian to be rated poorly by one in­surer and highly by an­other. That’s frus­trat­ing for ev­ery­one. There’s an ur­gent need to stan­dard­ize and har­mo­nize mea­sures and col­lec­tion so physi­cians are not flum­moxed by a dozen or more mea­sure­ment plat­forms. The trick is to har­mo­nize while pre­serv­ing flex­i­bil­ity so mea­sures and col­lec­tion can evolve and im­prove. In­no­va­tion must be pro­moted.

Ag­gre­gate data across mul­ti­ple pay­ers. Data is sta­tis­ti­cally iffy, and even mean­ing­less, un­less there is enough of it. Ag­gre­ga­tion of health out­comes data across mul­ti­ple pay­ers and in­sur­ers, pri­vate and pub­lic, sim­ply must oc­cur to achieve the num­bers re­quired to per­mit ro­bust as­sess­ments of qual­ity and per­for­mance at the in­di­vid­ual physi­cian level.

Pull data from EHRs as soon as pos­si­ble. One in four doc­tors is now us­ing a ba­sic EHR sys­tem, and 1 in 10 has a “fully func­tional” sys­tem. Many of the lat­ter group are af­fil­i­ated with HMOs and in­te­grated sys­tems. In 2011, all such health plans and sys­tems should test the ex­trac­tion of data for full pub­lic re­port­ing.

As for Physi­cian Com­pare, the ini­tial site needs an over­haul. It should in 2011 be­come a ve­hi­cle for pub­lic ed­u­ca­tion about physi­cian qual­ity, just as its sis­ter site, health­care.gov, helps peo­ple nav­i­gate the world of pri­vate and pub­lic health in­surance.

There’s no stop­ping the de­bate over the health re­form law. But there should be broad agree­ment that con­sumers de­serve more and bet­ter in­for­ma­tion on the providers in whose hands they put their lives.

Con­sumers de­serve

more and bet­ter in­for­ma­tion on providers

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