The expansion of information technology has put more and more data in the hands of patients. As patients have come to be viewed and to view themselves as healthcare “consumers,” there has been an increased demand for information concerning the consumable “product”—the physicians and hospitals from which they will seek care. Many consumers are familiar with Consumer Reports magazine, which provides ranking and information concerning top brands of dishwashers, and similarly several Web-based publications now offer consumer-based information for selecting a physician or hospital for medical services.
HealthGrades
One of the better known such services is HealthGrades, www.healthgrades.com,
which provides ratings on physicians, procedures, hospitals, and nursing home
facilities. Some information on this Web site is available at no cost, while
other information requires creation of an individual account and a fee. Because
the physician information HealthGrades reports is based on public records such
as state licensure and board certification, nearly all practicing doctors can
expect to be represented on the site.
HealthGrades was founded in 1999 with an initial emphasis on hospital quality ratings. Since then, its mission has expanded to not only include ratings, but also to offer employers and health plans services that guide employees and plan members in their care decisions. The HealthGrades Web site boasts three million monthly visitors and data on 5,000 hospitals, 16,000 nursing homes and 650,000 physicians. Based in Golden, Colo., the company also has an advisory arm that works with hospitals to understand their quality ratings and to improve upon them.
HealthGrades literature states that to compile ratings on physicians and hospitals the company uses the most current three-year data set available from the Centers for Medicare and Medicaid Services and from several individual states. It uses “advanced information management and statistical techniques” to risk-adjust patient data for hospitals to enable valid comparisons. The company compiles information from state medical board records, publicly available directories, and telephone surveys. Until recently the data on hospitals was updated annually while physician data was updated quarterly, and now data is updated continuously.
Visitors to the site are prompted to request information about a physician or a hospital. Physicians may be searched by name, specialty, or location. Once the appropriate physician is identified, the Physician Quality Report is offered for $19.95, although in some markets the cost is $29.95. Optional report upgrades are offered including a “malpractice search” for a $7.95 additional charge, and a “what physicians are paid” report for $3.95 more. To order the actual report, the patient creates a customer account profile and then has the option to pay online and immediately receive the report.
The actual report contains 12 sections. The first section includes general information concerning specialty training, medical school, residency and internship. The physician’s medical school, years since graduation, and residency programs are listed. Board certification is explained and listed as well. The next section deals with disciplinary actions, both at the state and federal levels. Any disciplinary action in the previous five-year period is reported. Closed malpractice claims, listed for 15 states, include claims settled out of court and those in which a jury verdict was rendered.
Two indications of “quality” are listed-the number of years since medical school and the presence of any government disciplinary actions—and compared against national norms. A reimbursement section lists certain procedures and their average Medicare physician payments in the home state of the physician. The next section includes a patient experience survey with the data about the trust level of the physician’s recommendations and whether or not the patient would recommend this physician to family or friends. No data is provided about the number of patients surveyed and, in fact, while national averages are listed, the site is extremely confusing as to whether an individual physician’s data is included in the table. Also listed are physician characteristics such as languages spoken and gender.
A “free physician research comparison report” lists information for four other local physicians in the same specialty, including each one’s address, record of malpractice claims, board certification status, number of years since medical school, gender, and foreign language spoken. The last section of the report concerns area hospitals’ quality ratings based on various specialty areas, but it frequently lacks data concerning neurological procedures or diagnoses. This section also discusses questions that patients should ask of their doctor when they are considering forming a relationship.
At the end of the report, a disclaimer states:
Healthcare provider ratings are statements of opinion and not statements of fact or recommendations to utilize any healthcare provider services and do not constitute medical advice. User is solely responsible for determining whether the information provided is suitable for their purposes, and reliance on the information is at the user’s sole risk. Users should obtain any additional information necessary to make an informed decision.
HealthGrades recently has received favorable publicity on a national scale. CBS News in a January 2007 report described two patients who used HealthGrades to compare prices for their surgeries at the Dartmouth Medical Center. The Washington Post in an April 20 article urged patients not to utilize Johns Hopkins Hospital in Baltimore but rather to seek care at smaller suburban hospitals for certain diagnoses, based upon the data listed at HealthGrades. Similar stories have appeared in the Wall Street Journal, Los Angeles Times, USA Today, Reader’s Digest, and on Fox News Channel.
The Fine Print
Few physicians would argue that it is reasonable for patients to be aware
of physicians’ demographic data such as schools attended, status of licensure,
and board certification. Additionally, much of the HealthGrades physician report
contains educational material to help patients understand what terms such as
“residency,” “internship,” and “board certification” mean.
But HealthGrades is not quite as unbiased as it initially might seem. Unlike Consumer Reports magazine, which does not accept any advertising or test samples in order to maintain its objective status in providing product reviews, the company allows physicians to pay HealthGrades to give site visitors a free report on their practices. Physicians may also pay HeathGrades to enroll in its “Internet patient acquisition program” through which the company will optimize the physician’s presence on major search engines so that potential patients can find the physician information more easily. Hospitals may pay to have themselves listed as a free item in a patient’s reports on physicians in their geographic area. HealthGrades will then link physicians who have contracted to provide their reports for free with the free hospital report to provide them with better visibility to any patient who is searching in that area.
HealthGrades also will contract with hospitals to provide “marketing solutions and services” to make sure that the hospital’s clinical excellence and patient safety are “broadcast strategically and effectively.” This would include the aforementioned search engine optimization as well as onsite consultative services to help analyze patient safety reports, clinical service line reports, and community hospital reports available through the site.
Other HealthGrades shortcomings include that data from a limited number of states is used to generate norms for comparison among physicians and hospitals. Additionally, no information is given about the number of patients who are surveyed in the sections on patient experience survey. Obviously, one disaffected patient could have an enormous impact upon a physician’s rating and this would not be discoverable based upon the listed criteria. Of note, there is only one physician listed among the entire leadership, management team, and board of directors of the HealthGrades organization.
Internet-based physician and hospital quality rating services are undoubtedly here to stay. Neurosurgeons should familiarize themselves with and perhaps monitor such services so that they are aware of what information patients are viewing about them and what information is being used by larger businesses and insurance companies in their contract negotiations. It is important to recognize that commercial organizations are not bound by the same rules concerning financial disclosure and relationships with their clients that govern physician activities. Even so, society must insist that physician information is objectively derived and statistically valid and that it is promoted it in an open and ethical manner.
Allen K. Sills, MD, is in practice at Semmes”Murphey Neurologic and Spine Institute, and he is associate professor of neurosurgery at the University of Tennessee Medical School in Memphis. The author reported no conflicts for disclosure.
Physician Rating Sites
A Google search was performed using key words: physician rating, rate a doctor,
doctor rating.
- www.bookofdoctors.com
- www.consumerconnection.com
- www.doctorscorecard.com
- www.drscore.com
- www.findadoc.com
- www.healthcarereviews.com
- www.healthgrades.com
- www.mdnationwide.org
- www.physicianreports.com
- www.ratemds.com
- www.ucomparehealthcare.com
| HealthGrades Checkup AANS Neurosurgeon interviewed Scott Shapiro, HealthGrades vice president of corporate communications and marketing, to clarify some key information for neurosurgeons. Is the physician information available from HealthGrades impartial? HealthGrades allows advertising on its Web site and offers physicians fee-based
opportunities to maximize their presence on major search engines and to sponsor
free reports for patients. Doesn’t this conflict with the essence of impartiality? How can physicians view the information that is published about themselves
in the comprehensive Physician Quality Report without being charged for a
report? If some information listed in the report is incorrect, how can a physician correct it? Last word: |