Rating Providers: Art or Science?

Affiliates Bulletin Vol. 14 No. 1 2009

There is now an abundance of rating systems for providers and institutions all aimed at helping patients find the “best” provider, raising standards for quality care, and serving as justification for hospitals and practices to receive increased reimbursement. Both public and private entities and combinations thereof have attempted to establish criteria by which to score hospitals and practitioners. Even Zagat®, known for its restaurant ratings, has teamed up with WellPoint in this venture. Since there is a large and diverse set of groups trying to help consumers pick doctors each with their own objectives and resources for analysis, it is no surprise that criteria vary widely from group to group. As a result, each ‘judge’ comes up with a different set of ‘winners.’ For example, the Centers for Medicare and Medicaid Services’ “Hospital Compare” uses hospital outcomes and patient experience while the US News and World Report’s “Best Hospitals” assesses hospital reputation and its mortality index among other factors to evaluate hospitals. Using a sophisticated formula to compare each rating system, researchers found a significant discrepancy in the conclusions made by these two evaluation tools (Halasyamani, L., Davis, M., 2007). This points to a real disconnect between the “best hospitals” pitched by the media and what more objective measure produce.

Which criteria does one use when setting out to rate providers? It is clear that using clinical outcomes or patient satisfaction data alone provides an incomplete picture. Several recently published studies expose the unfortunate reality that how a patient feels and what a physician records and concludes about a patient’s experience do not always jibe. For this reason, it is essential that both types of outcomes are used to evaluate the quality of a physician’s care. Even so, there are notable problems with collecting clinical outcomes data, such as how to adjust for differences in baseline patient severity scores and the existence of co-morbidities. There is also a well-founded fear among clinicians associated with soliciting patient feedback. Firstly, there are so many variables outside of a physician’s control that affect patient experience. Secondly, many patients that respond to such solicitation can have either extremely positive or negative feelings to report and therefore skew the overall portrait painted of a provider.  On the other hand, collecting such data can have its perks too; clinicians can discover ways to improve the services they provide while also pinpointing and promoting the areas where they receive high marks.

Because the initiative to rate clinicians has become so popular, one might assume that consumers rely heavily on this information to shop for healthcare providers. Do consumers really even care about this data? Findings from a national Health Tracking Household Survey of 18,000 people revealed that most people do not look online or in magazines for provider evaluations and comparisons (Tu, H., Lauer, J. , 2008). For example, half of individuals searching for a new primary care physician (PCP) sought the recommendations of their friends and relatives. Consumers also relied greatly on doctor recommendations, particularly when searching for a specialist. Furthermore, it was concluded that when choosing doctors, an individual’s utilization of online information on providers is relatively uncommon, ranging from 11 percent of consumers who looked for a new PCP to just 3 percent of consumers having procedures. These findings are thought-provoking given the surplus of Web sites with valuable information on doctors and hospitals. Either consumers aren’t being completely honest in their reporting or their search process really draws on a combination rather than single-sourced inputs. The NAFC Web site alone provides thousands of consumers listings of providers each month.

There is no doubt that the world of providing patient care used to be much simpler. These days, the service of healthcare is a competitive marketplace and finding health information is as easy as clicking a button. There are so many wonderful physicians leaving individuals bewildered about how to choose one over another. It is therefore logical for so many entities to have published easily accessible evaluations and comparisons of providers and institutions. Whether rating systems are currently a popular means for finding providers or not, there is reason to ponder what qualities are important to patients, and a necessity for organizations such as the NAFC to provide inquiring individuals with a justifiable recommendation. 

Halasyamani, L., Davis, M. Conflicting Measure of Hospital Quality: Ratings from “Hospital Compare” Versus “Best Hospitals”, Journal of Medicine, June 2007.
Tu, H., Lauer, J. Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice, Center for Studying Health System Change, December 2008.