August 17, 2016

Keeping Score: A CMS Ranking Program that Just May Work!

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Those who have read my past articles already know that I am not a fan of physician ranking or scoring programs. Checkbook USA and ProPublica each publish a scorecard that supposedly ranks the quality of care provided by physicians, and while they put a lot of time and solid research into their metrics, they lack one very major component: a review of medical records. Without that, their findings, while perhaps statistically sound, lack merit with regard to real causal results.

The bottom line: it’s a good screening program, but it doesn’t provide enough solid information, in my opinion, to empower a consumer to compare physicians with any degree of certainty.

Then we have these online programs such as Health Grades, vitals.com, ucomparhealthcare.com, Rate MDs, Dr. Score, and others that supposedly rate and compare different physicians. While some claim to have created algorithms that consider lots of data points, for most, those who are supposed to be real patients share their personal experiences with a particular physician, giving other consumers the opportunity to get a closer look at the physician-patient relationship.

The most obvious problem is that you don’t know if the person writing the review is a real patient or just a competitor. I recently went to leave a review for a physician (to test it out) and it made me click a box indicating that I was a patient of this physician. Really?  That’s how they validate it? If you look at the reviews from HealthGrades, for example, you will see complaints from folks who say they were actual patients of a physician but had their review blocked, or physicians who try to validate “anonymous” reviews or have them removed without success. I looked up my neurosurgeon, and the ratings were all over the place. One patient said that he walked into the hospital and left in a wheelchair. Another praised the courteousness of the staff and the short wait time. Personally, I think the staff are rude, and for my past three visits, my waiting time averaged just over two-and-a-half hours, but hey, the guy is a genius and he resolved my very complex spinal problem 100 percent. The overarching point is that most of these sites are based on anecdotes, and that’s not a good way to pick a doctor.

The Centers for Medicare & Medicaid Services (CMS) also got into the game by releasing Physician Compare in 2010, although it was not their idea, per se. The Physician Compare website was required by the Patient Protection and Affordable Care Act (PPACA), I suppose as part of what the administration claimed would be an improvement in transparency. But the data and other information provided are quite limited, and most of what is offered is readily available from physicians’ offices and on websites such as www.usnews.com/doctors. It includes basic demographics, plus information on education, training, hospital affiliation, and certifications. It also includes CMS quality program participation indicators such as those associated with the Physician Quality Reporting System (PQRS), electronic health record (EHR) and model of care (MOC) programs. But what consumer understands what these are all about, and who cares? They are pretty much useless when it comes to understanding quality of patient care, and in fact, they’re so useless that CMS is discontinuing some of them.

Then along came Nursing Home Compare, another CMS program that accumulates information and data for all 15,000-plus Medicare- and Medicaid-participating nursing homes in the U.S. What I really liked about this program was the level of detail provided by CMS on each of the nursing homes. For example, there are detailed reports on inspections for health and fire safety, food service, staffing levels, hours of care provided per resident, and quality metrics such as the percentage of patients with pressure sores, the percentage of residents with urinary incontinence, and more. It also lists any administrative actions taken against each nursing home. So I tried it (www.medicare.gov/NursingHomeCompare), and here is what I found.

I entered my ZIP code, and the system returned information about some 20 or so nursing homes within 20 miles. But that’s not a surprise; this is Florida, after all. It starts with an overall rating of 1 to 5 stars, and while I have not seen the actual algorithm used to create this rating, it is my opinion that it falls in line with the details of the issues (or lack thereof) reported. It then continues with a 1 to 5 star rating for health inspections, staffing, quality measures, etc., and it even lists the distances from my area to each nursing home. I can also select up to three nursing homes to compare; that was very cool. So I compare three and find stark differences between the ratings in the different categories. For example, for one there was a two-star (below average) rating on the health inspection. Clicking on that link, I got to a detailed report that identified the biggest deficiency: one of the kitchen staff preparing food without having his facial hair covered by a net. In another facility, there was a two-star rating for staffing. Drilling down into the details, it reported the total number of residents and total number of licensed nurse staff hours per residents per day, and even broke this out by RN, LPN and CNA. Benchmarks included those for the state of Florida and national metrics.

In general, I like the Nursing Home Compare system because while it does include some valuable metrics and statistics, it also includes detailed reports, and it gives me, the consumer, the ability to determine what is important and what isn’t. For example, the issue about not covering one’s beard doesn’t bother me. I have a beard and I never thought about covering it, even when making breakfast for the grandkids. But the staffing deficiency is definitely a concern, because I don’t want my mom or dad waiting hours to get a pain pill or to be cleaned up or for any other number of issues that would require staff intervention. 

The fact is that consumers (prospective patients and families) need to be more educated and informed about their healthcare providers. The problem is that there is so much bad information out there that it is sometimes difficult to wade through the noise to get to the signal. But that’s what we have to do.

When it came time for me to choose a neurosurgeon for what would be a complex reconstruction of my cervical spine, I did my research, including talking to staff at the hospitals where the physician worked as well other physicians, such as my primary and other docs for whom I asked him to solicit an opinion.

In the end, my outcome may be positive and it may be negative, but it won’t be for lack of doing my homework. In the world we live in, I would be willing to bet that most people spend more time researching a movie than they do researching a doctor, hospital, or nursing home.

No one said it would be easy, but then if it was, everyone would be doing it.

And that’s the world according to Frank.

About the Author

Frank Cohen is the director of analytics and business intelligence for DoctorsManagement, a Knoxville, Tenn. consulting firm. Mr. Cohen’s specializes in data mining, applied statistics, practice analytics, decision support, and process improvement. He can be

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fcohen@drsmgmt.com

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