Empowering the Patient as Consumer: Health Care Gets Grades

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As a journalist, I’m accustomed to doing research online. Before I interview someone, travel somewhere to report or cite data from an organization, I typically do a background search. When I decide to buy something, I operate pretty much the same way. If I need a new digital camera, I look at reviews on CNET.com. If I want to find a great Thai restaurant in my neighborhood, I head to Yelp.com.

But when it comes to our health, finding expert or even consumer-generated reviews is nearly impossible. Sure, there are message boards and online forums where people can chat with each other about medical conditions. In some states, it’s easy to find the vaginal birth to cesarean rates for hospitals. But generally, when it comes to getting hard qualitative data on doctors, hospitals or even insurance companies, we’re out of luck.

It’s true that when it comes to things as subjective as health and medicine, it’s hard to measure performance and doctors usually object to standardized grading systems. Every patient is different, they say. A doctor may have a better rate of successful surgeries simply because his or her patient pool is healthier to begin with. A doctor who sees sicker patients might, for example, have more patients experience complications but have critically important experience dealing with tough cases.

Yet, medical associations will also admit that, despite these kinds of objections, they often measure the performance of their member doctors — they just don’t release their findings to the public. Hospitals also often measure performance and keep it from the public. Fair or unfair, this secrecy breeds suspicion that doctors and hospitals have something to hide. Reporters who worked on a recent Dallas Morning News investigative series on a hospital system in Texas were repeatedly rebuffed when they sought quality ratings data. According to one story in the series:

“…the institutions refused repeated requests to release statistics on resident performance and patient outcome. “We want it dealt with among peers,” said Dr. Ron Anderson, Parkland’s chief executive…”

In a stark departure from the usual physician resistance to grading, the Society of Thoracic Surgeons recently decided to release heart bypass surgery data on its members to Consumer Reports. The publication (subscription only) used the data to rate doctors as below average, average or above average. The Society agreed to participate, in part, because the data set looked at a broad variety of factors to grade physician groups. (Individual doctor ratings are not provided.)

An opinion piece in the New England Journal of Medicine rightly called this “a watershed event in health care accountability.” It’s precisely this kind of transparency that’s needed to raise quality in the American health care system.

Notably, the new Affordable Care Act, which I’ll be writing much more about in this space in the months to come, takes a whack at grading as well. By 2014, the new law calls for the creation of state-based web sites where consumers will purchase health insurance. The sites will be portals and will include plan information, pricing and — thanks to a last-minute amendment added to the legislation — qualitative ratings for insurance policies. In other words, you’ll know how an insurance company measures up when it comes to paying claims, using premium dollars for medical care and not overhead and a myriad of other factors.

These are all steps in the right direction. With more transparency in the health-care system, patients can become the best brand of consumers, the empowered kind.

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