Wednesday, April 18, 2007

Health Care Quality Rankings Be Damned

Today pharmacy rankings produced by J.D. Power were posted on the Wall Street Journal Health Blog. It seems that even pharmacies are not immune to such rankings. The J.D. Powers’ ranking system is different that those created by individuals close to a particular industry and offers a glimpse into the minds of health care consumers. Issues like convenience, communication, economy and responsiveness to the consumer’s needs are paramount.

But remarkably I don’t use any of the pharmacies listed. I use my local pharmacist who lets me have a credit account, will deliver the drugs to my door (and those of many seniors in our area), and knows me (and my family members) by name. My needs must be different than those of the J.D. Powers survey respondents.

Not to be dissuaded, I decided to perused other rankings by J.D. Powers, particularly their Distinguished Hospitals ranking. It was interesting to note the dramatic difference in J.D. Powers “Distinguished Hospitals” for service excellence compared it the US News and World Report’s list of Best Hospitals. How remarkably different they are! Not a single university hospital exists on the J.D. Power list, but many university hospitals are on the US News and World Report’s list.

So which is better? Where should you receive your care?

It depends, doesn’t it? When we or a loved one is sick and hospitalized, we want the “best” care possible. But the best might be very different from one patient to another. For the young patient suddenly afflicted with a serious cancer, “best” might be the hospital center with the widest experience treating that form of tumor. For the aging senior who has been in and out of hospitals repetitively, “best” might be the center that makes accessibility and attentiveness to their daily needs most important (its amazing what free valet parking to do for a local center’s rankings).

But despite all of these rankings used as powerful marketing aides, the one thing that never waivers is this: the quality of the health care providers - the doctors, nurses, and technical staff (yes, even pharmacists) - is what really matters. Doctors that are not afraid to refer to others with more expertise, encourage second opinions, and look you in the eye as they speak are critical to me. Sure, the physical plant and information technology help, but if you can’t see your doctor quickly, talk to a real human being, and get the answers to your questions and support for your concerns in a timely and professional manner, you’ll take your health care business elsewhere - rankings be damned.

And you know what?

That’s the way it should be.



Conciergedoc said...

The trouble with determining quality care goes beyond institutions. This example below is exactly how the concept of quality care is still in the prehistoric times.

I recently came across this problem. My mother, 59 y/o healthy female, was finally convinced to get her screening colonoscopy. Her PCP gave her a list of 5 gastroenterologists. My mom wanted me, as her doctor to choose the best & safest. I thought this would be an easy thing to do.

First, I googled each MD. Nothing except the pay for listing on Healthgrades. Then I checked the recent ratethedoc sites. Nothing. Then I went to our state medical licensing board to see if any complaints passed. Here the data is hidden in hundreds of PDF files sorted by month and year with no search function and no master lists.
Then being a local doctor myself (but I am new to the area) I choose to call and speak to the offices and endoscopy suites practice managers themselves. I asked specifically, as per AGS guidelines, what is the doctor's average withdrawal time, and perforation complication rate. The PM's had no response and in fact were bothered by me asking, even defensive sounding. Instead, I get what passes as quality measurement now... "the doctor is excellent and never misses anything." I insisted on leaving a message for the MDs themselves. Despite leaving my contact info, none have called back to date.

I can imagine what must be going through their respective minds when they hear of my questions.
1) If he wants to know this, he probably is a pain in the ass patient and a litigious risk
2) I'm making enough money off referral, why do I need this type of patient.

So, at the end of the day and hours of futile research, my mom and I choose a doctor who has a nice sounding last name, & is in his 40s (theory - old enough to have experience, but not too old such that he has outdated habits).

Nothing like measuring quality of care. Consumers, beware.

If there any gastros (especially those that run endoscopy centers) who have begun to collect and release the indicators, love to hear why your colleagues do not.


DrWes said...

Great example, ConciergeDoc. Thanks for sharing.

I had a similar problem with my father - and it came down to finding an outpatient internist that still came in to see his patients in the hospital, rather than surrendering his inpatient care to a different hospitalist each week.

Unknown said...

I just stumbled upon this old post by searching for hospital rankings. I looked into the JD Power rankings, and their website says that 20% of hospitals can qualify. Still, only a few dozen are listed. This is because the hospitals have to request to be judged by JD Power and very few do. I hope you've started to do more research or thinking before writing your blog posts in the past 3 years.