Five hearts or thumbs up: Health plans rank MDs
Five hearts or thumbs up: Health plans rank MDs
Report cards reward best performers, data collection
Do you have a five-star medical practice, with patients who are elated with the care and service you provide? You'll need those top rankings to stand out in the newest wave of report cards that guide patients to the "best" providers.
Two major California health plans have turned their provider directories into report cards on quality and satisfaction, with hearts or other icons to show which medical groups attained the highest levels. Both Health Net in Woodland Hills and PacifiCare, based in Santa Ana, plan to eventually expand the Zagat-style directories to other markets around the country.
"We're trying to reward the best performers and give an incentive for others to achieve benchmark status," says Sam Ho, MD, vice president and corporate medical director of PacifiCare Health Systems.
While many health plans profile medical groups, this is the first time they have released the information to the public. That may make some physicians uncomfortable, but Ron Halbert, MD, MPH, notes that the health plan uses analytic methods that would withstand academic scrutiny.
"We have taken great pains to ensure the information we release is as accurate as possible and unbiased as possible," says Halbert, an epidemiologist and director of clinical operations in the quality initiatives division for Foundation Health Systems, the parent company of Health Net. "We regularly meet with medical groups and discuss how we measure member satisfaction and how we analyze the data once we get them back."
Both Ho and Halbert say consumers can evaluate quality-related information in health care as they do in other industries.
"Let the consumers decide," says Halbert. "I trust the members to make their own decisions if we give them good information."
Report cards generally compare physician groups to each other, giving the "thumbs up" or "five hearts" to the ones in the highest percentiles. But they vary based on what is measured and how the information is collected.
Health Net's first report card, released in March, covers 130 medical groups and compares them within five regions. Another 70 groups were not included because their survey size was too small to be valid, Halbert says.
The results are based on patient satisfaction surveys mailed to every Health Net member - more than 500,000 in all. Groups receive five hearts (excellent), four (very good), or three (good) based on patient ratings of 17 aspects of quality of care, access, and overall satisfaction.
Future reports could incorporate care-related measures, such as mammography screening and immunization rates, but Halbert called this a "first step" in a move toward greater accountability. "We have information on indicators other than satisfaction which we use for an incentive program at the medical group level that rewards groups that have better quality," he says. "In time, when the idea has been tested and there's more acceptance, I think the intent is to include that information in public reporting."
Member interest will shape the evolution of these report cards, Halbert says. For now, members must call an 800 number to request the report. They will not be mailed to all health plan members.
"We made an assumption that the people who would be most likely to want this information would be people who are already contemplating a change," he says. "We didn't feel it would be welcomed by every member."
Consumers choose on quality
PacifiCare has taken a different approach by adding icons to the directory of providers that all plan members receive. The icons will tell members which medical groups ranked in the top 10th percentile on certain measures of service and clinical quality. For example, indicators will likely include access to physicians, overall satisfaction, breast and cancer screening, and a measure of diabetes care, Ho says.
"This gives members more information than just geographic information and benefit coverages, which is the traditional approach to provider selection," he says. "Hopefully, we'll help educate [members] and provide meaningful choices based on quality."
PacifiCare will provide a detailed report with a breakdown of various percentile rankings of medical groups to health care purchasers. But members will learn only about the best of the best. If a medical group ranks in the 89th percentile, for example, it will not be recognized.
"It isn't a listing of the high quality groups," says Ho. "It is a listing of the benchmark or top performers. It gives [medical groups] a tremendous motivation to get to the top 10th percentile."
Yet getting to the top also depends on data collection, particularly in a capitated environment in which groups do not need to submit claims for payment. In other words, the "best" medical group may simply do a better job of collecting and transmitting information while the "poor" performer may have problems with information systems - not care.
In fact, improving data collection is a goal of these health plans. "This gives medical groups further incentive to not just perform but to record [data] and transmit [them] to us," Ho says.
Comparisons invite controversy
While both Ho and Halbert say they have received favorable feedback from some medical groups, clearly, these report cards stir some controversy and anxiety.
In California, groups also can voluntarily join yet another report card effort that is based on patient surveys and coordinated by the Pacific Business Group on Health, an employer and purchaser coalition based in San Francisco. Since each report card uses different measurement criteria, a medical group could appear on one as an excellent provider but not on another.
"As the performance measurement movement continues to evolve, we will attain more standardization and, therefore, more comparability," says Ho. "Until that happens, there's going to be significant narrative in our quality index to tell what it is and what it isn't."
Halbert notes that Health Net has published its methodology in peer-reviewed journals, such as the American Journal of Medical Quality.1,2
HealthCare Partners Medical Group in Torrance, CA, has added numerous programs to improve patient satisfaction, including a communications training program for staff and physicians, a running track and walking classes for cardiac rehabilitation patients, and other health education. Patient satisfaction enters into the performance review of providers.
But Daniel Temianka, MD, an internist and medical director for quality management, questions whether the assessments based on a narrow range of indicators really measure quality of care. "How does someone judge that I'm a good internist?" he asks. Ultimately, patients still rely on their own experiences and the recommendations of family and friends, he says.
Ho acknowledges that performance measurement is still evolving. "One of my favorite quotes is from Winston Churchill," he says. "'Don't ever let the better be the enemy of the good.' You have to start where you are and improve it from there."
References
1. Jatulis DE, Bundek NI, Legorreta AP. Identifying predictors of satisfaction with access to medical care and quality of care. Am J Med Qual 1997; 12:11-18.
2. Meng YY, Jatulis DE, McDonald JP, Legorreta AP. Satisfaction with access to and quality of health care among Medicare enrollees in a health maintenance organization. West J Med 1997; 166:242-247.
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