Saturday, January 30, 2010

Do Doctor and Hospital Ratings Matter?



The organizations that rate hospitals and doctors have proliferated as the internet has become mainstream over the past 5 years. I'm sure you have seen some of these: U.S. World & News Reports, Consumer Reports Health, Health Grades, Leapfrog, Hospital Compare, Americas Best Doctors and 100 Best Hospitals. My local magazine lists the "top doctors" along with full page paid ads and promos that are very compelling. The questions is, do consumers care? Are these rating agencies really steering people toward top quality in health care?

Each of these agencies and organizations that "rate" have different measurements and criteria for their choices. The top rankings do not necessarily relate to quality outcomes. The Medicare data are two years old. Different treatments and conditions are judged, so a "top" hospital in one area may be a loser in another.

Even the mortality rates for acute myocardial infraction (heart attack) that were in the top 50 hospitals in US News & World Reports were misleading . One third of the ranked hospitals were outside the best performing quartile based on mortality and 4 of them were within the worst performing quartile.

Where can a patient go to find out the outcomes of a hip replacement? What if I want to know the infection rate and the number of hips that require "re-do"? How can I find out information about my surgeon? How many has he/she done? Do they track outcomes one year after surgery?

Believe me, you cannot get this information. Period.

Patients are becoming more savey about health care choices but research suggests that rankings have little influence over those choices. "The primary care physician is still the leading source for patients seeing specialist physicians and the opinions of referring physicians remain the leading factor for an individual patient choosing a hospital", according to a JAMA perspective article.

For that reason it is important that patients have a choice and have transparent information on their primary care physician. Selecting a physician is done mainly by "word of mouth" and availability. The consumer websites where patients can rate doctors are imperfect, but without better ways to get information, more patients are looking there as they select a doctor.

We still don't know if the 5 star doctors are just nicer or if they are clinically better.

41 comments:

Jim Purdy said...

Often the only "rating" I care about is from state court records, as I check to see whether a doctor has been sued for malpractice.

If she has been sued, that tells me that she probably is good enough and confident enough to take difficult cases. So far, so good.

Then, if she won her case, so much the better. That's the doctor that I'll try to see.

But that's only the first step. At the initial appointment, first impressions matter. If she actually takes time to listen to my questions and answer them, I know I've found myself a doctor.

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Cary said...

I just used several rating sites to choose a new primary care doctor. I think they are helpful as long as you keep the scores in perspective. A 4-star doctor with 75 ratings is likely just as good as a 5-star doctor with 6 ratings. There will always be dissatisfied patients no matter how great the doctor is.

Anonymous said...

"We still don't know if the 5 star doctors are just nicer or if they are clinically better." This is really a good point that in some cases people can be unclear about if they don't know enough about their physician.

One time someone in a grocery store was going on and on about having such a great doctor and when I asked who it was I knew there was inside knowledge with some of the medical community of a problem of some chemical substance abuse this physician had interfering with practicing, but some people thought was a nice doctor giving them the samples and meds. they wanted, but maybe should not continue taking.

Toni Brayer, MD said...

Jim: Very funny. Hadn't thought of it that way about the malpractice.

Cary: I agree. The more ratings the better and understanding that the ratings are usually for communication skills, timeliness and niceness. There is still no way to know how good they are clinically.

Anon: I know lots of inside scoop about lots of physicians. When I see some of them on "top" lists I just groan. Usually the lists that come from doctors and nurses about their colleagues are pretty accurate. Some of the doctors on top lists practice at academic institutions and you will only see the residents. Kind of false reporting, I think!

KM said...

One thing I like about my doctor that I didn't think of ahead of time, is that besides being nice when a doctor cares enough to be tough on you for the right reason. Like taking a med.you don't want that in the long run might be better for you, or knowing when to refer you to a specialist you don't want to see for an unpleasant procedure or surgery, but will have a better out come.
It is nice to have a doctor that can listen but be confident and tough to push you to get the right medical treatment and care enough to do that. I saw two different doctors with the on going problem and switched to the one who kept pushing me and talking to me about the diagnosis being constantly, stably treated and a plan instead of letting it go. I like a doctor who is strong, confident, tough,but is open minded and listens, compassionate, as well as nice.

mitchsmom said...

"We still don't know if the 5 star doctors are just nicer or if they are clinically better."

I agree that this is a very good point... I'm a nurse and on our unit, the MD that would probably get the most popularity points is actually probably the *least* caring one of all... the one that loses a lot of popularity points because he "tell it like it is" (less sensitive, cutesy bedside manner) is really the most caring one and probably the sharpest... you really have to try to get a well rounded picture, and yes sometimes it's impossible to get all the information that would really help you make the best decision...

I say we should worry less about ratings & more about taking care of ourselves so we don't need to be at the MD's as much in the first place! :)
No, it won't prevent everything, but just not smoking and not being obese will cut out a LOT...

physical education courses said...

Some people are considering ratings and that, but when its a matter of life and death you'll just go to the nearest and most accessible hospital.

Rob said...

I think that PCP's should be better aware of these numbers. Unfortunately, we tend to refer by habit, rather than by who is best. It would be nice information to get - like when you take care of one of the OR nurses and find out who she thinks is good and who is bad. That opinion matters much more to me than just about any other.

Michael Kirsch, M.D. said...

Spot on! For me, a recommendation from a primary care physician I trust is the grade that really matters. The various physician quality measurements that are emerging measure lots of stuff, but I don't that they measure quality. Just because it is 'easy to count', doesn't mean it really counts.

@Jim Purdy, I was more persuaded by your last paragraph than the fisrt three.

Jonathan said...

Your specialist Medical Negligence Solicitors would have to prove that any negligent delay in the referral to the specialist caused a deterioration of the cancer or that had the referral been made initially a full recovery might have taken place. Your solicitor will need to obtain expert medical advice to assist with these questions. The legal tests of negligence and causation are difficult to establish and it is important that you seek early and urgent legal advice only from a specialist solicitor.

hospital solicitor  said...

it is very helpful to speak with a sympathetic but impartial expert.

Hospital Solicitor said...

Hi

The Injuries Board who are tasked to evaluate all personal injury claims in Ireland, do not handle medical negligence cases. This is because they require a highly competent hospital solicitor with experience of both medical matters and the hospital system. For example, a hospital solicitor will almost always require at least one report from an independent medical expert. Even knowing which expert to bring in to support your case requires a hospital solicitor to have deep knowledge in this area.

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I agree it is a good thing they do it with schools and teachers you should know how your local hospital stacks up when you compare them with others every should be given the same level of care.

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