Month: October 2017

Quality Reports for Hospitals and Doctors: Interesting but Flawed

By Mark A. Kelley, MD |10/18/17
Founder, HealthWeb Navigator

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 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% of the GDP, would have all these same features.

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

Healthcare information is primitive because it focuses 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 much else.

Federal regulations have helped improve online medical records and lab results. But information about healthcare quality is still lacking. The lack of standardization about what is important, credible, and measurable leads to confusion.

HealthWeb Navigator lists the most common online hospital rating websites. Unfortunately for patients, there is no consistency among these many rating tools. Research shows that hospitals ranked highly in one system often score poorly in another…and vice versa.

The reason? These rating systems all 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 information most valuable to them. Some websites promote doctors who pay to be listed on the website. Others feature those doctors with regional and/or national reputation. This approach is common in regional publications magazines like Boston Magazine that list the “best” local specialists.

Finally, the newest “report card” for hospitals and doctors is the popular website Yelp. Reports featured on Yelp remain controversial, as they are based on consumer opinions rather than a more data-driven methodology. Despite the flaws, Yelp reviews are extremely popular among consumers.

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

Most physicians, including me, think that the best source is still a recommendation from a trusted friend, preferably a health professional. 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 conveniently close to home. Others, especially those with complex conditions, may prefer to see a specialist in a large medical center far from home.

Once a hospital recommendation is made, the patient and their family can examine the hospital’s website to evaluate its staff and their credentials. 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.

As for doctors, you can check out their background on several websites featured in our “Physicians” section. Most hospitals list the educational credentials of their medical staff, including board certification.

Clinical experience is highly important when choosing a physician. That information may not be listed on a website, but every physician can and should be able to summarize their experience to interested patients. HealthWeb Navigator covers how to choose a doctor in more depth on a previous post.

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.