How doctors can respond to report cards

by an anonymous physician

Recently, Danielle Ofri had a piece in the NEJM about medical report cards.

You know, those computer generated reports that tell you how many of your patients have achieved normal blood pressures and normal cholesterols and so on. Dr. Ofri concluded her piece by shoving her most recent report card to the bottom of a stack of more important paper and heading off to see patients.

I wish life were that simple. The major health insurance company in our area posts report cards online and encourages patients to look at them when choosing their doctors. One of our local hospitals tells its doctors exactly how much each of the patients they’ve admitted cost or earned for the hospital. By coincidence, I’m sure, that report arrived the same week as the package of forms for re-credentialing.

Doctors have two major ways of responding to those report cards. We can change the way we practice, such that our patients will have better cholesterols and cost our hospitals less.

Or we can learn from insurance companies. Cherry pick compliant, uncomplicated, generally healthy patients, and gently encourage (remember those patient satisfaction scores) the complicated patients to seek care elsewhere.

Any bets?

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  • http://trishatorrey.com Trisha Torrey

    Another kind of report card – one patients can give their doctors to share their individual experiences with a doctor and his or her practice:

    Doctor’s Report Card

    The goal, of course, to improve communications between patients and their doctors – and vice versa.

    Trisha Torrey
    Every Patient’s Advocate

  • Manalive

    I recently received a bad quality score for failing to give the required condom speech to adolescents.
    I am, alas, a bad doctor.

  • http://www.occampm.com/blog Michelle W

    Your last point was echoed in a study reported by Medical News yesterday.

  • Max

    Don’t worry too much, guys. There have been grading websites for years as has been noted in another comment on this site. They sit unused. Hardly any reports. Hardly any reviews. The bottom line is patients have had access to information for years and they don’t use it. You can check out the docs with the most reviews and read all the horrible ones and patients still flood their waiting rooms. Again, it’s mostly (all) about the greenback. Are you on my plan? Yes? Good. I will go to you. God forbid you’re actually good and my copay is a whopping $10 vs $0.

  • bev M.D.

    I am sorry to see this was posted anonymously (just that it was felt necessary, not judging) and sorry that physicians continue to feel like victims in this respect. A recent post by Paul Levy on his blog , with a PARTIAL list of his hospital’s P4P measures, gave an idea how out of control these measures are for both hospitals and doctors:

    http://runningahospital.blogspot.com/2010/09/pay-for-performance-and-motivation.html

    However, I would also reference the recent publication in this week’s NEJM regarding the American Society of Thoracic Surgeons’ releasing their collected CABG outcome data to, of all places, Consumer Reports.

    My recommendation is that docs talk to their specialty societies and urge them to get moving and develop quality measures of their own, then negotiate with payors and CMS to institute these measures, instead of the current shotgun approach, where every payor has their own separate pellet, and they must all be dug out of different places in the providers’ bodies (bad analogy, but you get the point).

    If we do not take some sort of proactive action like this, then these measures will continue to proliferate (as we all know administrative types love bandwagons). I believe this can be solved, but physicians must be seen to be driving the bandwagon, not trying to resist it. It’s all in the perception.

  • http://www.BocaConciergeDoc.com Steven Reznick MD

    There is another option. You can become a direct pay practice and tell the insurance company bean counters to buzz off. That doesnt mean that you don’t try to set up an outstanding preventive program that utilizes the best guidelines and recommendations. It means that you charge your patients a reasonable fee, they pay you at the time of service and then they deal with their insurance company not you.

  • Solomd

    I might consider taking these report cards/doctor rating reports seriously if they actually contained accurate information. I received an “opportunity” to review patient data before Blue Cross came out with their doctor ratings. The first patient on the list was reported as being diabetic and I was deficient for never checking an A1C, never checking kidney protein, never checking diabetic sensory exam. Problem was that the patient was not diabetic and had never been diabetic. After spending 45 minutes clicking through screen after screen and looking in my EMR to try to prove that the patient was not/had never been diabetic, I gave up and logged out of the “opportunity”. Wonder what other inaccurate data was reported in the other six or so patients I didn’t even bother looking at.

  • http://www.pacificpsych.com/ pacificpsych

    Report cards are for children.

    I thought physicians were adults…?

    You cave in to this, tomorrow there will be more, and more…

    In the meantime, none of the nonsensical bureaucratic burdens are lessened.

    The goal of the system should be to free doctors from extraneous worries so that they can concentrate on the practice of medicine. Yet every thing in the system is set up to harass, burden, interfere, belittle and demean physicians.

    It’s your choice whether to bow your head and say, yes master–or not. Get all the physicians in your hospital together for a physician only meeting, admin not allowed. Decide you will no longer fill out one single piece of paper that you do not feel is necessary.

    Guess what: without doctors a hospital has nothing. Without doctors insurance companies have nothing.

    Stand up for yourself. No one will do it for you.

  • Chris MD

    What I am appalled at as how inaccurate these “reports” are-I have had had one in the3 last years that were useful. Patients that are recorded as not having lipids checked, or having mammograms have had them, and I waste time sending the copies back.
    If they are tracking the bills and not finding this, how will EMR help at all?

  • Anon

    Kudos to Steve who has it perfectly. You can join the borg and produce a uniform, homogenized product which is defined by the Govt or an Insurer as quality, or you can do it the old fashioned way, trying to emulate the style you yourself best typifies the practice of good medicine, and attracting and keeping a group of patients who appreciate your approach.

    While such an approach wouldn’t always achieve perfect balance of HTN, cholesterol and glucose, you would have a happy panel of patients who appreciated you and would send their family and friends to see you, and where lawsuits are less likely, since the patient knows you were trying to achieve what they wanted, not what their insurer wanted.

    The alternative? The ongoing spiral to a situation where neither doctors nor patients are content, but the bean counters and ivory tower “experts” are ….

  • http://www.nostrums.blogspot.com Doc D

    Report cards can be useful. I print them out and use the paper to make notes to myself (“pick up a gallon of milk on the way home.”)

    Seriously, I haven’t benefited, despite trying. The only positive thing I can say is, I’m so irritated by the alleged discrepancies that it keeps the criteria fresh in my mind (along with the irritation), so I don’t forget.

  • gzuckier

    I spent a few years doing q/a report cards based on claim records, not for doctors but for hospitals (as a cog in a larger organization, I admit). The difference was that the report cards were not for public consumption nor some sort of regulatory or quasiregulatory body, but for the hospitals to rate themselves; they paid handsomely with their scarce money for the service; and, most importantly, the criteria going into the reports were developed by MDs working in the hospitals themselves, and reviewed annually by those same doctors and the criteria tweaked to remove things which weren’t working and add new things which seemed promising and/or as standards of practice changed. These were not simple or easy, needless to say, and they were still not a 100% reliable indicator of quality, as all involved knew, but served as report cards should serve, even for parents; as a guide to suggest where attention may be needed and where one might begin with improvement efforts, with the possibility that in fact there may be other factors involved out of our control.

    Then NCQA came along with quasi-compulsory quick and dirty measures which sucked up all the hospitals’ QA money and that was that.

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