Now patients will rate you online

Short Take

Now patients will rate you online

A new Internet-based system will soon let them compare their care against the care other doctors provide. How will this affect your practice?

By Ken Terry
Managed Care Editor

You probably have patients coming to you clutching medical information they've picked up on the Internet. Or you may get new patients who chose you with the help of online physician directories that include data on your background, board certification, hospital affiliations, and even patient satisfaction.

If you find all this a tad disconcerting, take a deep breath—there's something else in the works. It's a clinical evaluation system that will allow patients to compare what you did for them with what other physicians did for their patients with similar conditions. The first elements of the system will start appearing on consumer health Web sites within the next several months. In the long run, this Internet program is expected to supply overall ratings of doctors' clinical performance.

What makes this new approach worth taking seriously is that it's coming from the Foundation For Accountability (FACCT), a Portland, OR-based, nonprofit coalition of large corporations, government agencies, and consumer groups. Together, these organizations represent about 80 million people.

When FACCT (www.facct.org) was formed in 1995, its founders believed that by giving employers and consumers reliable tools to compare health plans, they could create marketplace pressure to improve health care quality. But that vision hasn't panned out. Most purchasers have proved to be more interested in cost than quality; and by forcing managed care plans to broaden their provider networks, they've eliminated the ability to compare plans on the basis of participating doctors.

Moreover, consumers have largely ignored HMO report cards, even if they have a choice of plans. FACCT research shows that consumers perceive that the only way they can ensure quality health care is through their relationship with their individual provider.

So about a year ago, FACCT decided to design a new way to help patients evaluate and influence their own physicians. "The key is to enable consumers to understand the quality of care they're receiving and make decisions about their own care that are based on quality concerns," says David Lansky, president of FACCT. "We'll do that by giving people information about whether they're getting good care, using evidence-based standards and some subjective patient judgments. We'll also do it by compiling information that summarizes how other patients have rated the care they received, so that users can get an idea of how their care compares with other people's."

The patient-reported information—which, Lansky concedes, will afford only a partial picture of clinical quality—can be divided into four categories:

• Are key practice guidelines being followed?

• Are physicians involving patients in decisions about their care?

• How do patients rate their doctor's accessibility, communication skills, and trustworthiness?

• Are patients' symptoms well-managed, and is their quality of life as good as possible?

Lansky readily admits no one knows how much a doctor's care affects a patient's functional status. However, he says, "the health care system should be accountable for achieving improvement in some areas, such as managing asthma symptoms. Some physicians say they aren't responsible when patients don't get rid of environmental problems or don't take their medication. But FACCT believes health systems should be recognized and rewarded for achieving superior outcomes."

His emphasis on health care systems underlines FACCT's belief that doctors can be properly judged only within the context of their practice environment, their financial incentives, and the information available to them. But since consumers don't understand that, he says, "we need to talk to people about their relationship with their doctor as a way of beginning a conversation on quality."

As for the validity of rating physicians on their adherence to guidelines, Lansky stresses that the chosen protocols will be the most agreed-upon standards of care from specialty societies. "Let's take diabetes: A patient who's seen should have her feet, eyes, and blood sugar checked. We'll simply ask the patient, 'Have these things been done for you?' And in some cases, we'll give the patients some tips or feedback: 'Maybe you should ask your doctor next time to do this activity if it hasn't been done.' We're just enabling patients to ask the right questions and know what to expect when they interact with their doctors."

Drawing on the tools it developed for health plan report cards, FACCT will initially ask about several chronic conditions, such as asthma, diabetes, breast cancer, and coronary artery disease. It will also look at "life stages," such as early childhood care and end-of-life care.

When FACCT rolls out its clinical evaluation system, it will only be coaching patients on what to expect from doctors, says Lansky. Not until the methodology has been thoroughly tested and a large enough database built will FACCT enable patients to select and rate physicians on the basis of statistical performance data. Before that, however, the survey questions will help them evaluate their doctors.

The free service will keep patient health information strictly confidential, says Lansky. And while consumers will be asked to name their doctors, information on the physicians' practice and prescribing patterns will not be shared with FACCT's Web site partners. The value to them of hosting the service will come from its presumed ability to attract consumers to their sites.