As humans, our nature is to want to rate things. How many times have you said something was underrated, overrated, or properly rated? How many times have you gone on Yelp just to find out the best steak place in your town? How many times have you argued over which episode of Seinfeld is the best ever?
Okay, that last one is probably just me. Still, the point stands. We love to rate. It’s in our blood to compare, contrast and place things on a list.
HealthGrades.com and a slew of other websites have take this thirst to the world of healthcare. Need to book a doctor’s appointment? See what they are saying about Dr. Smith. Is he good? Is he nice? Is he easy to understand? Are his prices fair? How is booking an appointment with his staff?
These things matter in the world of accountable care. If patients were constantly complaining about one doctor in a medical group, wouldn’t you want to know who? Sometimes, it’s better to not let the receptionist randomly put you with someone. A random selection could mean poorer quality of care and higher out-of-pocket expenses. Would you let someone randomly pick a preschool for your kids?
This is why the government, in particular the Centers for Medicare and Medicaid Services (CMS), is rolling out Physician Compare. Physician Compare is a website mandated by the Affordable Care Act (ACA), and is an attempt to provide a legitimate ratings atmosphere to healthcare. It lists healthcare professionals who provide Medicare services, their basic information, hospitals they are affiliated with, and whether or not they participate in various quality reporting programs. The idea behind the latter is that if someone is participating in the physician quality reporting system (PQRS), for instance, they’re more likely to be a better practicing doctor.
Right now, the comparison data for clinical ability is limited. Only a select number of group practices and Medicare accountable care organizations (ACO) have data listed on only a few clinical quality measures. Eventually, Physician Compare is aiming do just that. It will compare physicians on clinical quality measures. It turns out this is way easier said than done.
I read a detailed policy brief from Health Affairs this week on the evolution of Physician Compare. It’s clear that we have a long ways to go until this website is delivering on the promise outlined in the ACA.
Building out the website has presented CMS with a slew of problems. Doctors have naturally resisted, in particular the comparison of outcomes measures. Most comparisons between doctors are of the process rather than what happened afterwards. The brief notes that as recently as August, the American Medical Association (AMA) promised to oppose any proposals to expand the Physician Compare website.
The doctors have some fair points. For one thing, we’re trying to promote the idea of a patient-centered medical home, with multiple providers acting as a team, but we still want to rate individual physicians? That seems a bit hypocritical. Then again, doctors are opposed to a lot of changes going on in healthcare. In theory, a physician comparison website is a good idea because it challenges everyone to do better. Can it be done in execution?
You can see that the implementation of this website includes a lot of shades of gray issues.
Moreover, CMS also faces technical and usability challenges. On the latter, it’s easy to see how HealthGrades.com and comparable websites have gotten so popular. They’re easy to use. A comparison tool with clinical quality measures, especially those with numbers, might not be as simple for consumers to digest. If it’s not simple, it won’t work. In terms of technical issues, the interoperability woes that are plaguing the world of electronic health records (EHRs) is having an affect on the website. Without connected systems, it’s hard to implement outcomes measure comparisons on the website.
It’s funny because you read about issues with integration, physician culture, and usability, and it sounds familiar. Indeed, most CIOs are dealing with those problems internally as they try to use EHRs to kickstart their own clinical quality programs. They can take solace in the fact that the government faces those challenges too.
One thing is clear; whatever happens in 2015 surely won’t be a smooth ride for both doctors opposed to this and the government officials trying to implement it. That also sounds familiar, doesn’t it?
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