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.
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