Tuesday, December 9, 2008

Do patients really want to see their doctor's report card?

Consumer-driven health care has been the cause du jour for large employers, consumer groups, and the Bush administration. The idea is that if "consumers" (patients) are given "transparent" information on the quality and cost of care of individual clinicians and health care facilities, they will choose the ones that offer the best value. Physicians and hospitals would then be "incentivized", so the theory goes, to improve their care and lower their prices, leading to overall quality gains and cost savings.

Often, health quality report cards are linked to financial models, such as health savings accounts, designed to encourage patients to set aside money to pay for their own care.

Underpinning consumer-driven care is the belief that patients want to see health quality report cards. And, that they will use quality and cost comparisons to prudently select physicians and hospitals that offer the best value.

But what if patients prefer to make health care decisions on intangible things - like a recommendation from a next door neighbor - that can't be captured on a report card?

Niko Karvounis writes in the Health Beat blog that "patients' health care priorities aren't entirely rational - and so relationships, and not rankings, are important ... Interaction is paramount." He cites an October Kaiser Family Foundation survey, which found that less than half of patients who come across comparative data on health care providers actually use it.

ACP has supported efforts to provide patients with physician-specific information on the quality and cost of care - with safeguards. Earlier this year, we expressed support for the "Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs", which has been endorsed by leading health plans, consumer, business, and physician groups. It includes the following principles:

- Measurement is based on sound national standards and methodology.
- Both consumers and physicians have input into the measurement process and how results are reported.
- Measurement is a transparent process so that both consumers and physicians can understand the basis upon which performance is being measured and reported.
- Physicians have adequate notice and opportunity to correct any errors.
- Physicians will have information that helps them improve the quality of care they provide.

Still, the Kaiser survey suggests that performance measurement and reporting programs may work best - if they work at all - when incorporated into models, such as the Patient Centered Medical Home, which support the relationship between physicians and their patients. The Patient Centered Medical Home encourages patients to have a personal relationship with a physician who is responsible for helping the patient get all the care they need, supported by a better payment system (including payment for services that fall outside of the office visit) and practice-based health information systems.

PCMHs report on the quality and efficiency of care, but it is the physician-patient relationship that is at its heart.

Today's questions: Do you think patients should have information on your health care quality and efficiency grades? Do you think such information will lead patients to make wiser choices in picking doctors or hospitals?


Steve Lucas said...

I believe a patient should have information concerning his/her doctor. The reality is most will not use this information in making medical decisions. I am a demanding patient. I expect to be seen on time, not be exposed to unnecessary test designed to generate income for the group or doctor, and I expect the doctor to at least make eye contact with me during the visit.

Reality is most people feel a long wait proves how busy their doctor is, test prove the doctor cares, and ignoring the patient establish them as a superior. Doctors who demonstrate this behavior are rewarded with a full schedule and patient panel that requires little personal interaction.

The change to the concept of a medical home will not only take a behavioral change on the part of physicians but also patients.

Steve Lucas

Jay Larson MD said...

"Value" and "Quality" are subjective and differ from person to person. An important part of practicing medicine is the doctor relationship with the person they are caring for. Our society is a bit obsessed with numbers. How can a relationship be given a meaningful number?

I would not mind having performance numbers such as the number of eligible patients receiving influenza vaccine during the fall available to myself and the public. This, though, does not define how good a doctor is as a provider. Performance measures are worthless if the patient's health and health belief system are not paramount. A person will find the provider that best serves THEIR healthcare needs.

The main problem with a doctor "report card" is the amount of time consumed by the healthcare system to generate the report. It is not like doctors have lots of free time on their hands.

Improvedliving said...
This comment has been removed by a blog administrator.
Steve Lucas said...

Dr. Larson makes a number of good points. Our comments reflect our respective perspective. Any measurement system must reflect real goals of patients and doctors.

Paperwork will be the death of us all.

Most disturbing in the doctor patient relationship are the artificial barriers place on us both by outside entities such as insurance companies or standards put in place with an eye to economic gain for a third party.

Steve Lucas

Anonymous said...

From the patient side of this equation:

Until the payment systems shift so the middleman is removed and patients are paying for their healthcare services directly, then it's not the cost we are interested in.

A report card that talks about the doctor's capability of helping us survive what ails us -- that's what we are looking for. We want to know that a heart surgeon has a good track record, or that a primary care doctor can actually fit us into the schedule when we get sick. We want to know that the doctor isn't arrogant, and that the staff actually gets back to us with test results or prescription refills.

Transparency is necessary, but unlike most of what I'm reading here, patients are less interested in transparency of cost and more interested in quality of care.

Trisha Torrey
Every Patient's Advocate