Sunday, February 10, 2008

Quality Report Cards Get an "F"

Surprise, surprise:
For the Annals article, researchers from RAND Health in Santa Monica, Calif., and the Veterans Affairs Greater Los Angeles Healthcare System examined peer-reviewed studies evaluating the impact of public reporting on the quality of health plans, hospitals and physicians.

The study found that "evidence is scant, particularly about individual providers and practices" and that "rigorous evaluation of many major public reporting systems is lacking." The authors said "the effect of public reporting on effectiveness, safety and patient-centeredness remains uncertain."
I can't tell you how many "quality" reporting systems still report that I am credentialed at hospitals from other states in which I no longer carry an active license.

Bottom line: No one is checking the credibility, timeliness, and accuracy of the data generated in these "quality report cards" and, like computers, it's "garbage in, garbage out."

As doctors, we can only hope that patients will rapidly abandon these resources once this ruse is exposed.

-Wes

Reference: Fung CH, Lim Y, Mattke S, Damberg C, Shekelle PG. "Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care." Annals of Internal Medicine 15 January 2008; 148(2), Pages 111-123.

* * *

Addendum 05:30AM CST 11 Feb2008 - I thought it would be interesting to just one of the "quality" report card schemes: Healthgrades.com, which advertises itself as "the leading destination for consumers researching physicians and hospitals online, with 3 million consumers searching the HealthGrades Web site each month."

But I was stopped in my tracks when I read the Healthgrades "User Agreement" which states:
"HealthGrades is not a referral service and does not recommend or endorse any particular Healthcare Provider (emphasis mine). Rather, HealthGrades is only an intermediary that provides selected information about Healthcare Providers. We do not offer advice regarding the quality or suitability of any particular Healthcare Provider for specific treatments or health conditions, and no information on this Site should be construed as health advice. The Healthcare Provider rating information consists of statements of opinion and not statements of fact or recommendations to utilize the services of any specific Healthcare Provider. You should obtain any additional information necessary to make an informed decision prior to utilizing any specific Healthcare Provider."
And yet, look at the trademarked names of their report cards:
"GUIDING AMERICA TO BETTER HEALTHCARE®, THE HEALTHCARE RATING EXPERTS®, THE HEALTHCARE QUALITY EXPERTS®, PATIENT-PROVIDER GATEWAY™, DISTINGUISHED HOSPITAL AWARD™, DISTINGUISHED HOSPITAL AWARD FOR CLINICAL EXCELLENCE™, DISTINGUISHED HOSPITAL AWARD FOR PATIENT SAFETY™, SPECIALTY EXCELLENCE AWARD™, HOSPITAL REPORT CARDS™, PHYSICIAN REPORT CARDS™, NURSING HOME REPORT CARDS™, HOME HEALTH REPORT CARDS™, HOSPITAL QUALITY GUIDE™, PHYSICIAN QUALITY GUIDE™, NURSING HOME QUALITY GUIDE™, HOME HEALTH QUALITY GUIDE™, QUALITY RATINGS SUITE™, COMPAREYOURCARE™, and SMARTCHOICE™"
Hmmm. Seems they're "offering advice" as to who's an "expert," or making assessments as to who's "excellent" in their chosen profession, eh? How can this be construed as anything BUT a "referral service," especially when they advertise their ability to direct traffic to your practice "Internet Patient Acquisition" service or their PATIENT-PROVIDER GATEWAY™? (All for a price, of course.)

Unfortunately, there is no responsibility for the reliability of data:
(Again, from their "User Agreement) "Some of the Site Materials, including but not limited to, certain healthcare information, product reviews, news, data, research, analysis and opinions, are provided by IIPs. As a general matter, we believe that the IIPs obtain such information, materials and other content from sources that they deem to be reliable. However, we make no representations with respect to, nor do we guarantee or endorse the availability, accuracy, reliability, completeness, currency, quality, performance, suitability, or correct sequencing of any information, materials or other content provided by any of the IIPs. We do not endorse, oppose or edit any opinion or analysis expressed by any of the IIPs. We assume no responsibility or liability for any information, materials or other content provided by any of the IIPs.
And yet hospitals and patients, it seems, clamour for this unreliable, unsubstantiated data and assume they're getting "quality" themselves, when the data are anything but.

-Wes

2 comments:

DermDoc said...

Wonderfully frustrating post. I just looked at the Healthgrades site -- the significance of "recognized" dermatologists in San Diego is beyond my comprehension. I can assure you that there are outstanding dermatologists who are not at all recognized and that I have never heard of most of the "recognized" physicians on their list. Wonderfully frustrating indeed.

Miriam Bookey said...

I agree...but how best to get a bead on a doctor's skills and care philosophy? I would venture to say through doctor-to-doctor referral networks combined with thoughtful, constructive patient reviews.

It's a shame that referral networks are so fiercely protected. Why don't primary care practices post online which specialists they refer to? I know that some consider referral trees more of a popularity contest than anything (yes, they usually support the doctors who have been in practice the longest), but I think online referrals would be both a timesaver for practices (fewer calls to request the referrals) and a boon for patients. The most referred-to doctors are the ones who would rise to the top.

Okay, so "top doctor" and "best doctor" organizations are doing something like this, but their listings online are outdated...some doctors are no longer clinically practicing, some listed are even deceased...we need a new way.