New doctors site rates for experience, quality

The first comprehensive physician rating and comparison database launches Monday in time for open enrollment on federal and state health exchanges, as well as for many employer-provided plans.

The new version of the website Healthgrades.com uses about 500 million claims from federal and private sources and patient reviews to rate and rank doctors based on their experience, complication rates at the hospitals where they practice and patient satisfaction.

The new way to find the best doctor comes at a time when many health insurance plans offer fewer choices of doctors and hospitals. Users can sort and compare physicians based on where they live and their insurance plans.

Insurers say their networks are pared down to save money and improve quality, but health care advocates say it's more important than ever to check out these quality claims.

The reduced choices have raised questions about access to the best hospitals and doctors, along with fears about high costs when consumers go to out-of-network providers. Echoing other industry officials, however, Sydney Zvara, executive director of the Association of Washington Healthcare Plans, says concerns about narrower networks of healthcare providers in Washington state are misplaced.

They are "high-performing, high-value networks ... with the best possible quality," she says. Insurers use a "deliberative process," looking at data and analytics to choose doctors and hospitals in their networks.

Leah Binder, CEO of the hospital ratings company Leapfrog Group, calls that largely "rhetoric" and says narrow networks are mostly about costs, including finding hospitals and systems that can offer one rate for all the services associated with one condition.

A study out Tuesday by Healthgrades on hospital quality underscores the importance of researching both doctors and the hospitals they're affiliated with. The study found that 17 hospitals rated in the Denver area for total knee replacement had complication rates that varied widely, ranging from 5.5% to 24%.

Healthgrades' new ratings are "game changing," in part because they allow consumers to easily search physicians by how much experience they have in a particular area or procedure, says Binder.

"It's all about finding the right doctor for the right procedure," says Healthgrades CEO Roger Holstein. "Frequency is really important to look at ... 20% of the doctors see 80% of the patients."

Binder warns, however, that while the volume of procedures a doctor does "can be a sign of excellence," it can also suggest a doctor is doing too many unnecessary procedures, "so consumers should use some caution."

Consumers ranked getting the "highest-quality" doctor above even finding one in their network, in an online survey of 2,000 consumers by management consulting firm Strategy&.

The federal Centers for Medicare and Medicaid Services has its own "Physician Compare" website, but it rates only 66 group practices and 141 accountable-care organizations (partnerships between hospitals and doctors) in effectiveness in five areas of diabetes and heart disease treatment. For the rest of doctors, it's only contact information, education and board certification.

Holstein, a former CEO of WebMD, was motivated to enter health care from the advertising field because he lost a sister in 1979 at age 19, 12 years after her pulmonary hypertension was misdiagnosed as epilepsy. Since that time, consumers have grown used to being able to fully research goods and services on sites including OpenTable and Zillow, says Holstein. So they expect and deserve it when it comes to health care.

"We're focused on solving that problem," he says. "It's a never-ending journey."

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