Connected Health: Pros and cons of publishing provider ratings

BOSTON—Physician ratings must be unbiased and independent to provide valuable and usable information, according to a panel discussion during the ninth annual Connected Health Symposium on Oct. 26.

John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center, said that getting information from unbiased sources is a challenge. Many ratings services rely on advertising, for one, and providers can combat negative user reviews. “The solution to the pollution is dilution,” he said, meaning providers can ask patients and staff to post positive reviews. Again, that is not an unbiased source of information.

As a result, Consumer Reports is focused on finding more credible sources of information. For example, the organization is partnering with the Society of Thoracic Surgeons around heart surgery data. They’ve learned some lessons, he said, such as making sure to get names correct. “You don’t look very good if you don’t but it’s a very difficult task for us.”

Massachusetts Health Quality Partners (MHQP) has partnered with Consumer Reports to publish providing reviews. The group “created what we thought was a level playing field,” said Santa. “For the most part, the physician market felt they’d done a reasonable job of creating and refereeing that level playing field. We needed experience working with partners like that to figure how best to present the information.” Now Consumer Reports is working with Minnesota and Wisconsin on reports on their physicians.

Rosalind Joffe, MEd, founder and president of ciCoach.com, said fitting in healthcare needs is a constant challenge for those with chronic conditions. Her own experience with autoimmune disease has led to dozens of doctor appointments with 14 different types of specialists. Her service works to match patient behavior and actions to providers. Patients must be more proactive to determine whether a certain provider is the best fit for them, she said. Part of the challenge is the “mystique of healthcare,” she said, but consumers should “think about what’s good for us. That’s a powerful and important step for the consumer and patients that providers see.”

Barbra Rabson, MPH, executive director of MHQP, is in favor of measuring quality and publishing it because “healthcare is a partnership. You can’t have a good doctor without a patient who’s knowledgeable and willing to work with you take care of their own health.” The Consumer Reports reports on providers help consumers learn how to get better healthcare and “can only help everyone improve the quality of care. The information needs to get out there more and more.”

There is room for improvement of the Consumer Reports physician reports, however. For example, the report published practice-specific patient satisfaction data. “That’s really not enough to measure a practice,” said Rabson. Patients might want to consider whether the doctor will see them when they’re in the hospital or in a nursing home. Rabson said her patients would rather wait to see her knowing she’ll see them in the hospital 80 percent of the time. “Access is not just judged by waiting time.” More and more patients have higher deductibles so they should have access to information about how charges vary. The data also doesn’t show which practices are concierge practices. “To compare a practice to concierge is not legitimate and undermines the concept of transparency.”

Another downside is the age of the data. The June Consumer Reports report used data from 2010 and things can change dramatically during such a time span. “In 2012, my practice was accredited as a patient-centered medical home. In 2010, my practice was a disaster for multiple reasons,” Rabson said.

Barbara Spivak, MD, an internist and president of Mount Auburn Medical Associates in Watertown, Mass., said she appreciates the concern about timeliness of the data. “The aggregation process takes time. EHRs will help with that. On the other hand, there’s a trade-off. If you wait until it’s perfect, you’ll never get it out. With every cycle of data, we learn a lot.” Despite the drawbacks, there is an upside, she said. For example, research indicates that patients are more likely to be adherent if they like their doctor which can reduce the risk of malpractice and clinicians can feel better about their job as well.

Another challenge associated with provider ratings is that satisfied patients are less likely to respond to a survey. Plus, more educated patients are more likely to demand more and therefore be dissastisfied, said Rabson. Chronically ill, aging patients “rarely feel good about any piece of this because they’re not getting any better,” said Joffe. Those patients are going to have a lower level of satisfaction but higher rates of interaction. “The higher the interaction the more it invades your life so the angrier you get.” That would certainly impact how they rate their providers.

Healthcare needs to catch up to other industries, said Santa. Consumers can look at reviews of cameras, for example, by choosing the data pieces most important to them. “The day you can do that in healthcare is foreseeable now.” The hip factor could be important as well. “Younger folks see us as white-coated, grey-haired folks who tell consumers what they should prefer. They’d rather have Mark Zuckerberg in a hoodie making a suggestion.”

Physicians are worried about this because the data are not very good, said Santa. Consumers are “deluged by advertising and promotions that don’t tell the whole story. That’s why Consumer Reports was founded 75 years ago. We’d like to think that healthcare is immune from that. Far from it.”