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This editorial December 27, 2002 by Karen Jurgensen shows just how sophisticated the American public has not become.  It is, according to her, best advised to rely on such information as the cited websites contain.  If there were ever an argument for due process, here it is.

Posted 12/26/2002 6:33 PM
Hospital ratings prescribe some patient relief but no cure-all

Compared to information readily available on most products and services, the quality reports hospitals will soon release are embarrassingly sparse. While consumers can evaluate how cars perform, from fuel mileage to repair problems, hospitals announced this month that they would provide data on how well they handle just three health conditions. And the quality measures are pretty basic, such as whether hospitals give heart-attack victims aspirin. Even then, the data won't be available until next summer, and hospital participation is voluntary.

For the health-care industry, however, the move is a giant leap forward. Patients are often forced to navigate in the dark, with almost no access to quality data that would let them pick the best hospital or doctor. The lack of uniform measures has produced a health system with wide variations in reliability that, as the Institute of Medicine reported last year, cost thousands of patient lives each year.

The dearth of information is particularly intolerable as health care moves rapidly toward a consumer-driven model that increasingly puts the burden on patients to choose providers and pay for care out of pocket. Yet, while hospitals are at least taking initial steps to better inform consumers, doctors for the most part remain resistant to the idea that they should be graded on quality to help patients choose the best care.

Last year, for example, doctors in Cincinnati opposed efforts by National Research Corp., an independent health-care evaluation firm, to rate them using patient surveys. They claimed the ratings were flawed, according to the American Medical News.

And AMA President Yank Coble complained recently about "the many ill effects of physician profiling," which would let consumers compare doctors based on quality care and patient satisfaction. Doctors say such ratings can be misleading: A physician who treats lots of complicated illnesses, for example, might look bad on measures that track patient outcomes. But technology has overcome such concerns by adjusting for the type of patients doctors treat to make fair comparisons possible.

Some comparative reports already are emerging despite physician opposition:

  • National Research has patient satisfaction ratings for primary care doctors in Cincinnati and Portland, Ore., on its Web site. directs patients to quality specialists for a fee.
  • In Florida, business groups are teaming to collect insurance-claims data and patient surveys to assign physicians platinum, gold or silver ratings. The report cards will be publicly available in a year, according to the Central Florida Health Care Coalition.
  • California's HealthNet is working on doctor ratings for its members, which will be up and running early next year.

While commendable, these regional efforts are only a partial solution. What's needed is an accelerated push by the federal government for national ratings. The Health and Human Services Department last month started publishing nursing home ratings. It plans to expand that to home health care next year, and eventually turn to hospitals and then doctors. The sooner the better.

Before patients can be expected to better manage their own health care, they must have solid data on physician quality. Doctors shouldn't keep them waiting any longer.

Posted 12/26/2002 7:55 PM     Updated 12/26/2002 7:55 PM
Medicine is more than science

Looking at facts and figures on a toaster oven or a car is easy. A toaster oven either toasts a bagel or it doesn't. A car's attributes, like miles per gallon, are also easily measured. But we all know that measuring the quality of medical care is a far more complicated task. That doesn't mean, however, that physicians are not committed to this effort.

In 1989, the American Medical Association (AMA) convened a group of private- and public sector health leaders to develop strong, fundamental attributes for clinical quality guidelines. At the time, generally accepted standards for clinical guidelines didn't exist, and abuses were rampant. The infamous Milliman & Robertson guidelines are a good example. Insurers embraced the M&R guidelines in the name of quality, but they soon came to be called the "black box" guidelines because physicians could not verify what studies or which experts helped shape them. Many believed these guidelines were being used simply to cut costs and limit care not enhance quality.

The AMA made it clear that a consensus of respected physicians or physician organizations must create and publicly endorse clinical quality guidelines. Such guidelines would focus on medical science, best practices and patient outcomes. Not on costs.

Today, the National Guidelines Clearinghouse provides physicians and the public with an electronic repository of current clinical quality guidelines, to be used as tools (not rules) and as guidebooks (not cookbooks). The AMA continues to convene physician experts not bureaucrats or bean counters to shape scientifically based measurement tools to help improve medical quality. This consortium has developed physician performance sets for preventive care, adult diabetes, coronary artery disease, prenatal testing, and major depression, and is developing sets for asthma and pneumonia.

And while such guidelines are needed to promote and achieve health-care quality, there must always be flexibility within these guidelines to account for the unique circumstances of each patient. Yes, medicine is a science, but it is also an art. Ultimately, patients will judge quality by whether their doctor is caring, compassionate and responsive to their health care needs. And while we must continually strive to improve quality, we should never forget that American medicine is still the envy of the world.

Yank Coble is president of the American Medical Association.