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Third-party payer ratings, social media grading sites more meaningful for physicians
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We are all aware of the multiple ratings that we doctors and the institutions where we work are subjected to every year. There is for me, as a Minnesota ophthalmologist: Best Doctors in the Twin Cities, Best Doctors in Minnesota, Best Doctors in America by a couple of ratings services, and recently even Most Influential Ophthalmologists in the World. In the past year I have been named to all these lists, but to my amusement, there have been years when I have been listed as a Best Doctor in Minnesota and a Best Doctor in America, but not a Best Doctor in the Twin Cities.
There are similar ratings for hospitals, the most prestigious being the U.S. News & World Report rankings of Best Hospitals for each individual specialty, including ophthalmology. Each of these ratings relies on interviews, usually by email, with a limited group of peers rating us and the institutions where we work. This is, of course, imperfect, and many excellent ophthalmologists who quietly go to work every day providing high-quality patient-friendly cost-effective care are not well enough known by their colleagues to make the lists. The same is true for many high-quality academic medical centers that turn out great residents and fellows every year while performing meaningful research. So, no doubt about it, these ratings are imperfect and perhaps at some level even blatantly unfair.
Still, having trained fellows in anterior segment surgery for 36 years now, I can say that the residents who enter our fellowship program, having been trained at institutions consistently ranked in the top 10, such as Bascom Palmer, Wills Eye Hospital, Johns Hopkins and Duke, have been without exception well trained and made excellent fellows. We have also had superb fellows from residencies not ranked in the top 10, but the consistent quality of residents turned out by the top 10 programs has made an impression on me. In addition, when I look at any of the Best Doctors lists, I am impressed that the physicians mentioned are nearly always doctors that I would be comfortable referring a patient or family member to for care. Thus, the imperfection is not that the doctors and institutions mentioned are of poor quality, but that equally high-quality physicians and institutions do not make the list.
Of course, someone has to be number 11 on every list, whether it be a top 10 in football, best-dressed women or most eligible bachelors. Even those ratings in which many rules are applied, such as Olympic figure skating, gymnastics and diving, generate extraordinary controversy, especially when a subjective analysis is the difference between a gold, silver or bronze medal or perhaps no medal after decades of training.
While I can easily imagine more objective ways to rate our colleagues and our institutions, I am not sure we would prefer them in the end. For example, the objective ratings now being used by many third-party payers to evaluate our individual or group quality of care, level of patient satisfaction and cost-effectiveness are also seemingly imperfect. And these ratings carry significant consequences beyond a bruised ego. Being removed from a provider panel of a major insurer because of deficiencies in any one of these three areas can be devastating to a doctor’s or group’s practice and financial well-being. To me, this is the area in which we and our societies need to focus our resources to make sure that these third-party payer ratings, which have real teeth and meaningful consequences, are fair and objective.
In the future, and even today, it is possible to be on every Best Doctor list as determined by your peers but not make the cut to be on the provider panels that allow you to retain your current patients or recruit new ones. This and social media grading services such as Angie’s List and the like are in my opinion much more important to every doctor’s future than any of the Best Doctors lists. I suggest we focus our attention on the lists that really matter.