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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