Tag Archives: Consumer Reports

Hospital ranking disagreement isn’t the only such problem

What do you think?

What do you think?

I love the latest Health Affairs article showing about disagreement among hospital ratings. In case you missed it here are the key takeaways:

  • Not a single hospital was rated as a high performer by all four rating systems, including Consumer Reports, US News, Leapfrog and HealthGrades
  • Just 10 percent of those rated as a high performer by one system were rated as a high performer by even one other
  • Some hospitals were rated as top performers in one system and bottom performers in another
  • The disagreement is apparently due to the fact that each of the systems focuses on different areas

This is definitely a head scratcher for patients deciding where to go for care, but at least a patient can decide what matters to him or her and then consult one or more of the ratings.

This isn’t the only serious shortcoming with ratings. Another, more insidious problem arises when raters agree on what measures to use. Case in point: pay for performance and physician quality measures used by health plans.

Even when the plans are ostensibly measuring the same thing, such as percentage of diabetics with HbA1c under control, there are problems. Quantitative definitions of what “under control” means vary slightly, but enough to throw off the results. Beyond that, the plans only measure the results from their own patients. When a physician office deals with several plans –as most do– that’s confusing. Physician practices can face a similar situation as the hospitals  mentioned in Health Affairs: top performers according to some raters and problematic according to others. That makes it pretty tough to identify priorities and measure progress.

The solution for physician practices is to use consistent definitions and data for all their patients, not payer by payer. In an accountable care driven world, physician practices (as well as hospitals and other providers) may find opportunities to operate in a more coherent, holistic, less fragmented manner and to deliver excellent care to all their patients as a result. If so, that will further weaken the value proposition for health plans.

Image courtesy of jesadaphorn at FreeDigitalPhotos.net.

By healthcare business consultant David E. Williams, president of Health Business Group.


DOCTOR Project launches consumer-friendly reports on physicians (transcript)

Jim Chase, president of Minnesota Community Measurement

Jim Chase, president of Minnesota Community Measurement

This is the transcript of my recent podcast interview with Jim Chase, president of Minnesota Community Measurement.

David E. Williams: This is David Williams from the Health Business Blog. I’m speaking today with Jim Chase. He is president of Minnesota Community Measurement.

Jim, thanks for your time today.

Jim Chase: Hi, David.

Williams: Jim, Minnesota Community Measurement is managing a new initiative called The DOCTOR Project. What can you tell us about it?

Chase: Well, this is the project we’re hoping will build new ways for people across the country to be able to share and find reliable information about healthcare performance. Things have changed a lot in the last couple of years. There are regions that have pretty robust information on the performance of providers and the communities in healthcare. And this is the first time we’ll be able to put information together across communities so a national employer or a national publication can use it.

Williams: I understand there’s a goal to work with ten communities to develop consumer-friendly reports. Have those communities been selected yet? Is there an opportunity for new communities to join? Where do things stand?

Chase: We’re in the process of contacting these ten communities that we know could be ready for the first publication, which will probably be in 2015. We’re working with them over the next few months to identify what data they have and finalize the agreements. We’re getting the word out as we’re finding that others who weren’t aware of this are interested in joining. So we expect this to be an ongoing process. There may be some who aren’t ready today but will be in a few months.  So, we’re hoping to get this started with the first ten but we hope that this gets people interested and that we’ll see more communities participating in the future. I also hope this is an opportunity when the information comes out, that people in other communities will ask, “Why can’t I get this kind of information on my physician?” And we’ll see a growth in areas that want to participate.

Williams: Jim, the term communities is a little bit vague. How big are these communities? Are they whole states or regions? Are they towns or cities?

Chase: It varies a little bit. There are several initiatives that are statewide. There are  statewide initiatives in California, Minnesota and Massachusetts.  Also communities around Cincinnati and Cleveland, OH. So we’ll see a mix there, but we want it to be large enough to be of interest to a national organization. We realize that not everybody is able to be statewide at this point.

Williams: I understand the initiative is focused on consumers. So, assuming your project gets going and is a success over these communities, what would it mean for consumers? How will it help them on a practical basis?

Chase: It’s interesting, in almost every segment of our economy active consumers drive improvement and value, and the same control can hold true for healthcare. So, making available this information we found in our own communities has motivated the healthcare community to take steps to improve the outcome and value of the care. It gives them information to where they can focus, but because it’s public, it also motivates change. And we also think this information can help the patients themselves get better care. Surveys have shown that more people want information to help them choose a provider that’s best for them.

We also plan to combine provider and performance information with tools and other resources when we put this out. It helps patients get better care for themselves. How do they work with their physician? What kind of questions can they ask? What can they do to help themselves get better outcomes?

Williams: I know you mentioned publications and talking about 2015 for an initial publication date. I also saw that Consumer Reports is involved and I know that they’ve been involved in some prior work that you have been associated with as well. How is Consumer Reports involved in this DOCTOR Project?

Chase: This is actually building on a project that we did with them in 2012 and ’13, where three regions – communities in Minnesota, Wisconsin and Massachusetts – partnered with Consumer Reports to publish an insert in their magazine with the local data that we had. And one of the things we found from Consumer Reports was they really needed to be broader to affect more of their subscribers. So, they’re going to be a really important partner in this work. We hope to publish results in some issues of their magazine next year.

And they bring some really important things to the mix. They have an audience of subscribers that are used to using this data, this kind of information, to make choices. And they can get the information out there to a lot of people. That was very important to us. There are a lot of subscribers in Minnesota. We want to be able to take the data  in all these communities and get it to where people are and where they’re looking for information.

They also have a lot of experience on how to present information, so it’s useful for consumers. Many of us in the healthcare industry are used to talking to physicians in the hospital about this kind of data but we haven’t had as much experience in working with consumers. So it’s a great opportunity to partner with them, with their expertise on how to talk plainly to a knowledgeable consumer audience and get them information that they can really use to help themselves.

Williams: Jim, you mentioned that some data is available in different communities and there’s sort of a mix between communities that are well-served and those that are less-served. I know that you can go to the Web and find commercial vendors where you can search for information on your doctors. Then at the federal government level, you’ve got sites like Physician Compare.  How does the effort that you’re talking about here differ from what’s already out there?

Chase: One thing that we know that’s different about healthcare from many other environments is if you ask the public, “Who do you trust for information like this”, they say, “My doctor.” And so, that’s a little bit of a challenge. We don’t want that information to be biased and just have the doctors’ perspective but we know we need to get buy-in from the local providers that this is good and useful information. So, that’s the reason why we’re working with these multi-stakeholder groups in these various communities to be able to have a table where they sit down and get buy-in, both in the local medical community that data is accurate and useful for care, but also other stakeholders such as patients, employers and health plans to push for information that’s really useful for the consumers.  And it’s that balance, I think, that is going to give us the most useful data, showing where there’s variation, room for improvement and help us take the data to where the people are.

Williams: You mentioned that the project is getting going now and you expect to have some initial publication in 2015. What’s the time frame for this project? Is this something that will start up and wrap up or is it meant to be ongoing?

Chase: It’s ongoing. Much of this year is going to be collecting data and doing the validation and comparisons and packaging it. We hope to have the initial publications in early 2015, but we want to pilot it there and continue to have it be a function where it can grow. We can add other communities and we can actually move to other national audiences that may have an interest. Again, one that we know that is interested is Consumer Reports but we hope there will be others such as national employers, or other organizations that need data on a national basis that would be interested in working with us.

Williams: You’ve been talking a lot about data that’s derived from the community and the medical providers there. What about data that’s coming from patients? The information that patients are generating about their own outcomes or their own experiences. You certainly see a lot of that on the Web these days as well. Does that fit into this project or would that be outside the scope?

Chase: No, it’s absolutely something that we also hope to investigate and I think the key here is we know that the public would like to have more information about patients like them and are willing to accept information in many other settings (and I think they will in healthcare) about what did other patients or other people that interacted with the system think about.

One of our challenges in healthcare has been it’s really hard with these local healthcare areas, the diversity across the communities, to get enough patient volumes. So, this is big enough for people who want to respond to really make that data reliable. It’s an opportunity, I think, if we can bring some of the data that comes from providers locally to the public. We can also ask the public to share information that they have about the providers. And so, it’s a very interesting exchange of data that would benefit both – clinicians who are trying to figure out how to improve the care but also patients who are trying to find out from other people what are they thinking and what kind of experiences do they have.

Williams: A lot of the information that’s out there, and I think also the focus with the prior work with Consumer Reports, is on primary care physicians. And I understand that’s the key point of entry for consumers in the healthcare system. Are you expecting this to focus just on primary care physicians or are you also thinking about specialist physicians as well?

Chase: I think it’s going to be a mix. Our first few efforts will probably be in primary care, because that’s where we have the most experience with data. It’s probably easier for some consumers to understand the relationship they would have with primary care, what they might expect for the care that they would get there. But I do think there’s a great opportunity for this to apply, especially when people are looking for a procedure that they may have some choice in and want additional information. I think that’s very important thing for the future.

When it comes to patient experience data, that’s something that certainly crosses not just primary care but people can get standardized information about patient experience on many specialty practices as well.

Williams: The Robert Wood Johnson Foundation is a partner in this work. What’s their role in it?

Chase: Well, Robert Wood Johnson Foundation is a great partner here. They made a major investment over the last seven years through the program called Aligning Forces for Quality in helping communities to develop this kind of information and motivate patients and providers to work together to improve care. They recognize all healthcare is local and you have to start at that level to really drive change. And things go on locally in healthcare, not just in Washington. And so, we hope this project is going to help them bring that work that they’ve done to the national stage, help it grow by getting more communities to join, and that it’ll pay additional dividends for the investments that they’ve already made in moving this kind of work forward at a community level.

Williams: Jim, this has been a very informative discussion. Are there points that we have not touched on that you want to make sure to cover?

Chase: One interesting aspect of healthcare is that this gives us an opportunity to explore things further unlike the things that Consumer Reports typically explores . If you’re shopping for a snow blower, it’s all about the snow blower. In healthcare, it’s really a combination of what the provider can do and also what patients need to do to get them better care. And so, this is a little bit of a different environment and I think one that we can address well, where we combine the information that we have from providers but also give people information about what they can do to get better outcomes for themselves in working with their providers.

Williams: Well, Jim, it’s been a great year for snow blowers in both Minnesota and Massachusetts, so I’m hopeful that the next few years will be just as good for information about physicians so that the consumers can make the right choices.

I’ve been speaking with Jim Chase, president of Minnesota Community Measurement. We’ve been talking about The DOCTOR Project. Jim, thanks again.

Chase: Bye-bye.

By healthcare consultant David E. Williams of the Health Business Group