On Dec. 30, 2010, the Obama administration launched Physician Compare, a website that will eventually include data gleaned from the Medicare meaningful use incentive program and that has the potential to dramatically change the way Americans choose their doctors.
Imagine comparison shopping for a doctor based on patient reviews, a set of easily comprehended measures of quality and other criteria. It's one of the Holy Grails of a truly patient-centered system!
The health reform law required HHS to launch the site by Jan 1. For now, it's mainly an updated directory of doctors and other health care providers nationwide -- 932,000 in all -- who accept Medicare beneficiaries. It's searchable by ZIP code, city, state and medical specialty. Doctors who are participating in Medicare's Physician Quality Reporting System have a mention of that in their profile. Those participating in Medicare's electronic prescribing initiative will have that added to their profiles this year.
The long-term plan is to add information to the site over time, with the reform law pushing the government to post the first patient assessments and measures of clinical care quality by 2015.
In our view, Physician Compare is very much a companion to the electronic health record and meaningful use initiative. Both will evolve over many years, separately but inexorably tied together. The ultimate goal is to have a consumer-friendly, easy-to-navigate site that contains a robust set of meaningful clinical and patient assessment measures that fairly assess physician quality of care, drive physicians to improve and permit consumers to make choices based on their individual needs.
But getting there from where we are today will be no small task. Here are some major challenges:
Consumers want data on individual doctors.
Physician groups raise legitimate concerns about the statistical robustness of some clinical measures as applied to individual doctors rather than the group practice level. The numbers on some measures will simply be too low to allow for valid results. This issue needs immediate attention, and we are confident ways will be found to work around the "low numbers" problem. Indeed, development in this area is active, including assessment of when EHR-derived data will be ready for prime time.
needs to move aggressively to require measures that matter to patients.
The meaningful use measures developed for phase 1 (2011) of the EHR incentive program and those being developed for phase 2 (2013) are focused on areas poorly measured in the past but of great importance to most Americans: patient safety; care coordination; patient and family engagement; appropriate treatment; and efficiency. The new measures all tilt towards outcomes and away from process measures. CMS -- which is administering the Physician Compare site and the EHR incentive program -- needs to build on this work to offer consumers an easily understood "dashboard" of measures. The agency needs to push to make that dashboard a uniform way to assess quality of care in different settings, including the new experiments launched under the Center for Medicare and Medicaid Innovation and other provisions of the Affordable Care Act. Perfect measures don't exist. So, the perfect must not be the enemy of the good. A fair process that involves the participation of the physician community must be put in place. However, that community and its trade organizations cannot be permitted to undermine the development of meaningful measures -- or stall Physician Compare -- based on endless arguments about methodological soundness, the validity of measures and risk adjustment. We recommend a posting of an initial dashboard of measures in 2014.
Health care delivery -- and its measurement -- isn't static.
While Congress designed the EHR incentive program around the notion of a "certified EHR," the emerging reality is that health care is often delivered, and patients manage their own health, outside of the doctor's office or hospital. Cloud- and Web-based applications, smart phones and tablet computers, home monitoring and other platforms will manage increasing shares of our society's personal health information, and many other caregivers and providers will be critical to our health system. Measurement and reporting should take full advantage of the rapid changes in information ubiquity and accessibility.
CMS should join the social network revolution (on a trial basis). A batch of websites now permits people to "rate" their doctors. The volume of such ratings is increasing rapidly, but most doctors rated on such sites don't yet have enough reviews to make the results statistically valid or meaningful, and the input can be manipulated. Still, there's potential here. In fact, even as tens of millions of people are using Facebook and Yelp and other Web services every day, many in the health "quality measurement" industry haven't had much luck luring consumers to their public reporting websites. Maybe it's time to bring information to the places where consumers already go and take a page from their books on what engages people. Accordingly, we recommend that CMS experiment with creating a section on Physician Compare that allows consumers to provide reviews of their own physician(s) using a standardized online survey tool. Initial results from this effort could be analyzed closely before they are publicly posted. If executed with care, such consumer reviews could become an important adjunct to other data and information on Physician Compare.
Who first? There are over 450,000 practicing physicians in the U.S. CMS may want to consider prioritizing a subset of them for measurement. We think surgeons -- and physicians whose practices involve doing invasive procedures (i.e. gastroenterologists and colonoscopy) -- should be prioritized for measurement and public reporting, with relevant and selected measures that get at their success, volume, complication rate, patient reviews, etc.
The directory must be accurate
. At a public comment session on Physician Compare last October, CMS officials declined to divulge the error rate in the present provider database -- names or addresses or specialties that are wrong, etc. -- but the error rate is believed to exceed 10%. If that's true, it will undermine trust in the site and get Physician Compare off to a poor start. CMS this year should launch a comprehensive review of the directory's accuracy and report the results to the profession and the public. In doing so, it should take advantage of the many existing government and commercial directories already being maintained for business reasons by health care stakeholders. CMS also needs to establish a much easier process for doctors to correct mistakes on the site as the current process is cumbersome. As quality and performance data get added to the site, doctors will need a clear review process that adheres to the standards set out by the Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs developed by the Consumer-Purchaser Disclosure Project in 2009.
Medicare's treasure trove of data on doctors, combined with the hoped-for stream of data from EHRs, will be a rich source. However, Medicare is not the only entity gathering data on doctors. In the private sector, insurers and employers have been aggressively pursuing physician accountability. The reform law requires that Physician Compare use "data that reflects the care provided to all patients seen by physicians, under both the Medicare program and, to the extent practicable, other payers." We urge the rapid development of all-payer databases, which will allow CMS to gain greater access to the data needed to populate Physician Compare with information that comprehensively assesses how physicians care for all their patients.
Alerting the public.
CMS needs to start developing a marketing plan for Physician Compare now. The agency has shown -- with its rollout of the Medicare prescription drug program -- that it knows how to get information about new tools into the hands of millions of beneficiaries. Still, Hospital Compare, CMS' website that presents comparative hospital data, was never marketed and the vast majority of Americans (90% in one recent survey) do not know about it. One new model: healthcare.gov, the government's new site aggregating advice and data on health insurance. Over four million people have visited the site since its October 2010 launch.
Physician Compare is being launched as forces propel us into a new era of health care accountability. Implemented well, it has the potential to be a game changer for consumers, but only if the government is bold, decisive and innovative. Yes, the site must be fair to doctors, but we have a right to know how doctors measure up when we put our lives in their hands.