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Almost 40 years ago, when I was a medicine intern in Portland, Ore., I saw the future and did not know it. I noticed people reviewing some of my patient charts every day. Who were they and what were they up to? They turned out to be staff for the heart surgeons who were collecting data on the outcomes of open heart surgery.
Eventually, I saw the heart surgeons use this data — they improved survival in a variety of ways, identified adverse events as they used new techniques, responded to our concerns about the risks of open heart surgery in patients older than 80 years, gave patients a better sense of the pros and cons of surgery and made decisions about the makeup of their group. They knew before others, for example, that left internal mammary artery grafts were a better initial graft than vein grafts.
Fast forward to 2013, and I find myself (a general internist) now working for Consumer Reports (CR) and focused on performance comparisons. I feel fortunate because CR has been at this for more than 75 years, has a well-established approach to comparisons and is an iconic brand that is highly trusted due to our independence from industry. But when it comes to physicians, it is hard to imagine collecting data at our labs in Yonkers, N.Y. Instead, my job is to find the best data available via either public or private resources. I recently described those efforts to more than 200 orthopedic surgeons at the American Academy of Orthopedic Surgeons Annual Meeting, Volume to Value, organized by
Anthony M.
DiGioia III,
Editor
Comparative data
Public comparative data on physicians is at an embryonic stage. While actively collecting and analyzing their own data, insurers or government are still searching for the right approach. Four years ago, we were fortunate to collaborate with the Society of Thoracic Surgeons (STS) to make performance data public from more than 200 consenting groups. Robust data on isolated coronary bypass graft survival, complications and adherence to guidelines was made public. Since then, we have worked with regional health improvement collaboratives in Massachusetts, Minnesota and Wisconsin to publish primary care-oriented performance information on patient experiences, clinical quality and disease prevention.
What have we learned?
- Accurately identifying physician groups and practice sites is a challenge. Private efforts often do not need to worry about this aspect since the public never sees the information. But for consumers, the first test of usability and accuracy is whether you get the name and location right.
- Consumers want to know how patients like them experience care. This goes beyond satisfaction and includes communication, coordination and staff performance. User reviews are a start, but we think a more scientific approach is preferable. But it is expensive and time-consuming in terms of data collection, analysis and presentation.
- Reporting on clinical quality is a challenge, but it can be done. We think it is likely best done by involving physicians in key tasks like risk-adjustment, weighting of elements in a composite and presentation options. Patients trust physicians when it comes to quality and the resulting comparisons, we think, will be more credible as a result. We think consumers are especially concerned about safety. Patients do not expect to be infected or injured in hospitals.
- Cost is the most challenging and most difficult to find good data about and present so consumers will understand it. But, demand is growing for this information. We hear many physicians want patients to have “skin in the game” as they make decisions. But how can they do so when they have no idea how much “real skin” or financial skin they might lose?
- How the data is presented is crucial. We have seen many examples of great data that is presented in ways that make it almost impossible for consumers to understand. We know a lot about our audience and are fortunate to have experience with symbols, summaries and narratives that make our information easier to understand and use.
- We have been rewarded by our readers for this work. Several of our articles are among the most frequently read content in CR history. A recent PriceWaterhouseCooper survey identified CR as the leading source of health reviews for consumers. Information about physicians is popular on news stands
Consumer Reports Magazine published hospital ratings as related to inpatient elective surgery in its September issue. Using Medicare fee-for-service data from 2009 to 2011, we engaged a research team led by
We looked at 27 surgical groupings and chose to publish an overall assessment for each hospital and specific ratings on five surgical groupings that showed significant variation. Three of the five involve orthopedists — knee and hip replacement and back surgeries.
We wish more hospitals and surgeons would better step up to this task. Unfortunately, studies have been done showing that many hospitals do not accurately report surgical adverse events via claims. Financial incentives, in some cases, encourage over-reporting, and in other cases discourage it. Hundreds of registries now contain information that could be more accurate than claims data. But almost all of those efforts are private ones that explicitly assure physicians and hospitals the data will never be shared with the public. We need to find a middle ground.
Transparency
The STS model should be the industry standard, but its sophistication and cost to physicians and hospitals are a challenge. But if specialty physicians seek to convince consumers that their focus is truly on patients and the best outcome possible, it seems they have a professional responsibility to step up like STS or cooperate with the government to publish equivalent information.
We know many will see our recent publication as “disruptive.” But, we do not think consumers should wait any longer when data that is informative is available. In 2010, CR and Leapfrog played a lead role in publishing large amounts of data on hospital-acquired infections. More data on hospital safety has followed.
We are committed to transparency in terms of methodology and look forward to comments that will improve the quality of our comparisons. For example, we will be working with STS and others to better understand how their data on major complications compares to the Medicare data we have just released.
Orthopedics is at a crossroads. The surgeries you do have become some of the most common surgeries in the health care system. Consumers want the outcomes orthopedic surgeons can offer. They also want to know the risks, including how much variation there is in risk by hospital and surgeon. They deserve to have the best outcomes at a competitive price. It is our collective, professional responsibility to make that happen.
References:
www.pwc.com/us/en/health-industries/publications/scoring-patient-healthcare-experience.jhtml
www.consumerreports.org/cro/health/doctors-and-hospitals/index.htm
For more information:
Disclosures: DiGioia has no relevant financial disclosures. Santa is medical director for Consumer Reports Health. He is a full-time employee of Consumer Reports.