Friday, April 23, 2010

Public Ranking Of Healthcare Providers Is Good, As Long As We Get It Right (Part 2)

Yesterday I discussed a popular hospital public rating list that may or may not be a little misleading. But physician providers are also increasingly subject to this type of rating. Commercial health insurance providers are the main groups putting together these ratings. Some are using this information internally to influence physician behavior or weed out costly providers. Others are going public with the information to help their clients pick the top providers. Again this is helpful as long as the information is truly accurate. In some cases it apparently is not.

A new physician rating group that was co-developed by Blue Shield of California and the Pacific Business Group on Health has come under fire by the California Medical Association even before it releases its first report. The CMA claims the new report has gross inaccuracies and disturbing flaws. Meanwhile the group generating the report, the California Physician Performance Initiative, says that the report is based on data for up to eight quality measures on 13,000 high volume doctors in the state. The CMA charges that much of the data is irrelevant but more importantly, the study does not take into consideration the patient's role for being compliant with the physician's directives. This is another whole dynamic that I will discuss more next week.

This brings me to the last point on this issue. Even the reporting of clearly accurate and objective data can be misleading. Let's consider the reporting of hospital mortality rates. To many this seems like an obvious way to judge a hospital's quality of care. The higher the rate the poorer the hospital. This is great except that it is totally false. Many hospital deaths are expected an unpreventable no matter how stellar the quality of care. In some cases the hospital's role is to provide palliative services and ease any suffering during a patient's final hours. A hospital with a strong reputation that takes care of a high percentage of critically ill patients is naturally going to have a higher mortality rate. What is needed is a list of totally preventable deaths. Wouldn't the plaintiff's attorneys love to get a hold of that list?

The concept of public rating of hospitals and physicians is a good one. It not only helps the public to make informed decisions, but keeps hospitals and physicians on notice of their need to provide high quality but cost effective services. But this only works if the information used for the rating is accurate, relevant and interpreted correctly.

More on this later.

Mark Brodeur

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