How They Rate

Mar 23, 2008  •  Post A Comment

How does the viewing public know what makes a good doctor, a good hospital or a quality health care plan?
A lot of the information comes from rankings published in consumer magazines and picked up in other media, such as US News & World Report’s annual ranking of America’s best health plans.
But some health care professionals and journalists question whether some ratings are simply popularity contests or marketing and advertising tools for the physicians, hospitals and insurance companies that get high ratings.
“It’s kind of a Wild West out there and almost impossible for consumers to determine what is reliable information,” said Andrew Holtz, a veteran health reporter. “Medicine is old-fashioned. It works the way most industries worked 100 years ago, based on personal relationships rather than objective measures. It’s not like the auto industry, where quantified test results are available.”
No Standard
With no consistent standard of measurement to determine the criteria for the highest scores, it seems as if each organization or publication has its own set of data and metrics. That concerns Trudy Lieberman, president of the Association of Health Care Journalists and a professor at CUNY Graduate School of Journalism, who was instrumental in developing ratings for Consumer Reports in the early 1990s.
“We want to take a step back and see if they’ve helped improve the marketplace or gotten in the way of policy discussions,” said Ms. Lieberman, who is moderating an AHCJ conference panel on the validity of ratings for health plans, hospitals and doctors. “The theory behind it is that the best would rise to the top, and the ones who didn’t would wither away. This is probably one of the first times we’ve examined this. There’s a fair amount of academic literature, but this is one of the first attempts to look at it for journalists.”
One of the ratings organizations for consumer health insurance plans is the National Committee for Quality Assurance, a nonprofit whose mission is “improving the quality of health care through measurement and accountability through all levels of the system.”
“Consumers desperately want and deserve information about the quality of doctors, hospitals and health plans,” said Richard Sorian, NCQA’s VP for public policy. “The media, by its nature, is attracted to controversy. Too often, that means coverage focuses on disputes over how to measure performance instead of the value of measurement and the need for improvement.”
The organization looks first at clinical quality, building measures of performance that ask whether patients get the right care at the right time. It reviews medical research regularly to see where there’s consensus about what makes for effective and efficient care. It asks consumers for their opinions about the quality of the care and service they receive. And finally, it examines the structure of HMOs and PPOs to be sure that they are protecting consumers’ rights in making decisions about what to cover and who they allow to deliver care.
“There needs to be more information about the choices patients can make about their care,” Mr. Sorian said. “For example, a woman with breast cancer has many options available to her, but may only have information about a few of them. Patients are being asked to make choices—often life-or-death choices—about their care without the information needed. The media can help fill that gap.”
With doctors, it’s common knowledge that some people stick with a doctor because he or she is “nice.” On another AHCJ panel, participants will look at the elements of what makes a good doctor and how to translate that information to the public. Some of the factors include good office hours and getting prescriptions quickly, but what’s harder to determine is if the doctor is making the right diagnoses and providing a standard level of care.
“When doctors are highly rated, it is often who is most involved in professional associations and has published the most papers, and not directly related to who is most likely to give you the most quality care,” said Mr. Holtz. “The head of the local chapter of a professional association is going to rank higher because they’re better known, but that does not mean they’re up to date with the standards of medical practice.”


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