Why quality reports for hospitals and doctors are interesting but flawed

Every patient eventually asks the same question: “How can I find the best hospitals and doctors?”

The solution might seem easy, since we live in a world where information is readily available on the Internet. In a few clicks we can shop for goods, review consumer products, market ourselves on social media, and complete financial transactions instantly. You would think that health care, which accounts for 17 percent of the GDP, would have all these same features.

Think again. Health care information for consumers is woefully unsophisticated compared to other industries. Ask anyone who has ever attempted to find prices for health care services, interpret a medical bill, or schedule an appointment online.

Health care information is primitive because it is focused on finances rather than customers — that is, the patients. As a result, hospital and physician offices are skilled at sending bills but often can’t help patients with anything else.

Federal regulations have helped improve online medical records and lab results. But information about health care quality can be confusing.  It lacks standardization about what is important, credible, and measurable.

There are several well-known hospital quality websites, but research shows that hospitals ranked highly in one website often score poorly in another and vice versa.

The reason? These rating systems use different measurement criteria, as well as different statistics to compute results. Some are heavily influenced by reputation rather than clinical outcomes. Even Medicare’s rating system — Hospital Compare — isn’t very helpful since it’s hard to navigate and most hospitals come out “OK.” Many patients choose not to use these “quality” tools due to the inconsistency among them.

Report cards about doctors are not much better. Medicare’s Physician Compare suffers from the same problems as its hospital-focused counterpart. The average visitor has difficulty sorting out the quality information most valuable to them. Some commercial websites list doctors who pay to be listed on the website. This marketing approach is not aimed at assessing physician quality. Other websites list doctors based on a national or regional poll of their peers. This model, while interesting, is based on anecdote and offers little objective information about physicians’ clinical performance.

Finally, the newest “report card” for hospitals and doctors is the popular website Yelp. This rating service remains controversial, since the physician reviews are based on consumer opinions alone rather than data-driven methodology. Despite this flaw, Yelp reviews are popular among consumers.

In the midst of all this confusion, how can someone find a good hospital or doctor?

I think that the best source is still a recommendation from a trusted friend, preferably a health professional. It is what physicians tend to do for their families and friends.

Those in health care usually have a network of helpful contacts. Of course, many other factors can influence patient choice. Most patients prefer medical care that is nearby and convenient. Others, especially those with complex conditions, may want to see a specialist in a large medical center far from home.

Once a hospital recommendation is made, the patients and their families can examine the hospital’s website to evaluate its staff and their credentials. A Google search of the physician may provide additional useful information.

Some hospitals publish their staff’s expertise and experience in certain specialties. Such voluntary public reporting is becoming more common among hospitals that perform at a high level. If a hospital does not list such metrics, it is worth asking for them.

Clinical experience is highly important when choosing a physician. That information may not be listed on a website, but every physician should be able to summarize their experience. Patients are requesting this information more frequently, and physicians should be prepared for that discussion.

In summary, publicly reported hospital and physician “scorecards” are interesting and sometimes helpful — but not necessarily authoritative. We have a long way to go before “public reporting” in health care represents an accurate reflection of clinical performance in ways that consumers can understand.

In the meantime, the best approach is to contact a trusted source, especially a physician or nurse. Ask them where or to whom they would send their loved ones in times of need. That recommendation is bound to be reliable.

Mark Kelley is a pulmonologist and founder, HealthWeb Navigator, where this article originally appeared.

Image credit: Shutterstock.com

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