Physician Compare, a U.S. website created to help patients find high-quality doctors, is missing so much information on individual providers that it may not be helpful, a new study suggests.
Quality reporting has been a work in progress for almost three decades since a landmark 1999 report from the Institute of Medicine, `To Err is Human,’ concluded that tens of thousands of patients deaths each year were the direct result of medical errors.
Physician Compare is the flagship effort by the U.S. Centers for Medicare and Medicaid Services (here). But while more than 1 million clinicians care for Medicare enrollees, only about 239,000, or 23 percent, had any quality information at all available on the Physician Compare website, researchers report in JAMA Internal Medicine.
And virtually none of the doctors had data tied to their individual job performance.
“To truly be able to inform patient decision-making, it is imperative that the data accessible to patients and their caregivers capture a large swath of clinicians,” said lead study author Jun Li of the University of Michigan in Ann Arbor.
“Patients should be able to use the quality information to distinguish higher from lower performing clinicians,” Li said by email.
In the current study, only about 21 percent of primary care providers reported some individual or group information related to outcomes from their practice. But almost all of this data was at the practice level, making it hard for patients to know who might be a better or worse choice among several physicians at one clinic.
And half of them provided details on no more than one or two quality outcomes.
Doctors who did share individual level outcomes tended to have very high quality scores, suggesting that physicians may only opt into the voluntary reporting system when they know the results will make them look good, the study authors note.
Clinicians also aren’t required to report data on outcomes for every patient, and they may choose only to submit information for cases that turned out well, researchers point out.
“Given its voluntary nature, it is not a surprise few doctors submit to this platform,” said Dr. Vineet Arora of the University of Chicago Medicine.
“The group that does is the `army of the willing’ and likely early adopters in the quality movement,” Arora, who wasn’t involved in the study, said by email. “More robust uptake would likely require mandatory reporting, financial incentives, and also improved ease of reporting using electronic health records to avoid adding increased burden to physician practices.”
Currently, there are no meaningful, publicly available data for patients to use in assessing physician performance and quality, said Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center.at Northwestern Medicine in Chicago.
“In fact, the current data are more likely to mislead patients than to be informative,” Bilimoria, who wasn’t involved in the study, said by email.
Even at a time when many patients face steep, and sharply rising, out-of-pocket costs for their care, it’s still very hard for them to effectively comparison shop, said Dr. Anupam Jena of Harvard Medical School and Massachusetts General Hospital in Boston.
“Provider performance is a black box,” Jena, who wasn’t involved in the study, said by email.
“Outside of health care, there are many ways to assess the quality of things that we purchase, ranging from clothing, to electronics, to professional services,” Jena said. “Even within health care, we have a large amount of data on the comparative effectiveness of drugs, since this information is often mandated by the FDA, but we have very little information on how doctors compare to one another.”
Date: May 14, 2019