PUBLIC REPORTING OF
EVIDENCE-BASED MEDICINE AND
Thomas James III, MD
hear the consternation in meetings and feel
the frank anger in the doctors’ lounge. This is
not a Louisville phenomenon, as there exists
the same intensity of angst in meetings at the
Philadelphia County Medical Society or in
meetings in Washington. Doctors are upset
not only about the quality metrics employed
by CMS and private insurers but also about
ratings based upon patient experience of care.
The measure of patient experience of care most commonly used by
government or commercial payers is termed Consumer Assessment
of Healthcare Providers and Systems (CAHPS). This tool was originally developed by the federal Agency for Healthcare Research
and Quality (AHRQ) to provide input into evaluation of health
plans. But they then enlarged the concept to include all health care
providers—thereby retaining the “HP” in CAHPS.
So, why this increasing push to have report cards on how patients
rate doctors, and how are they being used? There is a chasm between
the beliefs of physicians and those in the consumer movement.
Physicians look to the established doctor-patient relationship as
the appropriate measurement concept. But payers and consumer
advocacy groups look to find tools that allow people who have been
in the health care system to report their experience. Some organizations prefer standardized measures of patient experience of care
such as CAHPS. WellPoint entered into a controversial arrangement
with the restaurant review organization, Zagat, to manage its patient
experience data. But other groups tout the social media as the way
people should select doctors, medical practices or hospitals. The
Consumers Union (CU) forged a relationship with the Society of
Thoracic Surgeons (STS) to publish the results of the STS survey
of outcomes-based care on a hospital by hospital basis. The CU
sought the permission of the institutions to publish the ratings,
and a number of low-performing hospitals allowed their results to
be published. On the other hand, such popular websites as Angie’s
List push the envelope with patients’ visceral reactions to the care
received—placing patient perceptions of the peripheral aspects of
care on the same level as technical skills and clinical outcomes.
The public reporting of physicians by the Centers for Medicare
and Medicaid Services (CMS) has pointed out the real effect of this
information. Physician Compare is one of the newer tools out on
the Medicare website. This tool joins Hospital Compare, Nursing
Home Compare, and other such tools available to consumers. At
this time the information is rather limited and not of much value.
For that reason it is not utilized much by patients in selection of
their doctor. But CMS plans to provide more data and to publicize
this website more. Their goal is to use this information to encourage
physicians to change their practices. By tying the results to physician
incentives, this forum for public reporting has some tangible teeth.
Websites such as “Patients Like Me” (http://www.patientslikeme.
com) were started by families and patients who had gone through
significant illnesses, and wanted to connect with others who had the
same conditions. As more people signed on, the site began providing
people with access to research trials through ClinicalTrials.gov, and
provided a platform for self-reported data. So rather than become
an angry blog, Patients Like Me has morphed into a tool to bring
science and patients together.