Louisville Medicine Volume 62, Issue 8 - Page 8

PUBLIC REPORTING OF PHYSICIANS—COMBINING EVIDENCE-BASED MEDICINE AND PATIENT EXPERIENCE Thomas James III, MD I 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 6 LOUISVILLE MEDICINE 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.