Federal doctor ratings face accuracy, value questions

Consumers searching this fall for the best doctor covered by their new public or private insurance plan won't get very far on a federal database designed to rate physician quality.

The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It's so limited, health care experts say, as to be useless to many consumers.

This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament.

A report out last week by the Georgetown University Health Policy Institute said insurers were limiting the choices of doctors and hospitals for those buying insurance on health insurance exchanges to keep premiums low.

The CMS data include only 66 group practices and 141 accountable care organizations (ACOs). There are about 600,000 doctors in the USA, tens of thousands of group practices and more than 600 ACOs, which are partnerships between doctors and hospitals to treat a group of patients efficiently.

The database lists just five areas of doctors' effectiveness in treating diabetes and heart disease. These include whether doctors prescribed aspirin and how well they controlled diabetics' blood pressure.

"They are behind, there's no doubt," says Terry Ketchersid, a kidney physician and vice president of clinical health information management for the electronic health records company Acumen.

"The goal of these sites is for the average Medicare beneficiary to go out and make an intelligent choice," he says, but only another doctor would understand what to make of the ratings.

The CMS plans to add more quality measures and patient experience data for ACOs this year, spokesman Aaron Albright says. He says the CMS uses a "phased approach for public reporting to make sure the data are accurate and the measures reported help consumers make informed health care decisions."

"Over time, consumers will be able to find even more quality measures for even more providers," he says.

The agency has been at odds with the American Medical Association over the comparison site, which the AMA said last month is "riddled with problems." The AMA opposes the use of star ratings for doctors, even in its present limited scope.

"Star rankings or similar systems that display disparate quality scores in a simplified graphic result in distorted, inappropriate distinctions of quality for physicians whose performance scores are not statistically different," the AMA said in comments to the CMS last month.

The AMA urged the CMS to ensure the accuracy of all physician data before adding information to the database, called Physician Compare.

The AMA says it favors the phased-in approach that limits the quality data available but says the CMS shouldn't add data until it fixes errors in the system.

Some consumer advocates suspect that undue influence by the powerful doctors' lobby has slowed the process.

"AMA is doing everything in its power to stop transparency around outcomes in an effort to protect its physician interests," says Kathleen Bartholomew, an author and registered nurse who is a patient safety advocate. "It's not a new battle."

John Santa, an internist who is medical director at Consumer Reports, agrees the AMA is slowing the process but says "a delay by CMS to me is not a good thing, but if the information is in good shape when it is released that is much more important."

Despite its limitations, the CMS database, though designed for Medicare patients, could be the best available measure of physician performance available because of its size, and it's used by outside groups, including Consumer Reports, to develop their own ratings. Doctor groups and ACOs are submitting quality data to the CMS and getting payment bonuses when they do well in key quality measures. Next year, they will be penalized when their scores are below a certain level.

John Haughton, a geriatric rehabilitation doctor who works in health care information technology, says any delays or accuracy questions are less important than the fact there is progress toward transparency.

"The whole movement towards health reform ... is working because we broke the status quo," Haughton says. "It's not as critical that it be perfect this year or next year, as that ... (it) is moving in the direction of the system being better than it is now."