munity that this new rating system was coming. Nor were we provided an op- portunity to review the information in advance of its posting.” Organized medicine’s letter calls on CMS to give physicians additional time and opportunities to correct their infor- mation before posting it on the website, particularly for practices that don’t have or can’t afford robust quality measure- ment or EHR systems.
TMA Council on Health Care Quality member Ghassan Salman, MD, adds that faulty information, particularly when it comes to quality, could pose unintended harm to patients’ health and to physi- cians’ livelihood. The Austin internist was TMA’s 2008–12 representative to the AMA Physician Consortium for Per- formance Improvement. “The last thing we want to do is send
out wrong information about anybody. This information is very specific about the health care of the patient, and it im- pacts the physician’s reputation,” he said.
“We have to make sure the information is correct. And we have to make sure it is shared with the physician or the practice before being published.” According to the JAMA study, 35 per- cent of patients who sought online phy- sician ratings selected a physician based on good scores; 37 percent avoided phy- sicians with bad scores.
Lost in translation Fortunately for Scott & White, Dr. Berry and her staff found no errors during the review process.
“It is nice that we are the people re- porting our own data,” she said, adding that the stars are relatively easy for phy- sicians to figure out.
That may not be the case for patients,
however. Dr. Berry described a number of nuances to quality reporting that can get lost in translation when CMS trans- forms the information into the ratings patients ultimately see on Physician Compare. For one, to satisfy certain quality
measures, physicians must do a lot more documentation, which doesn’t necessar- ily reflect the quality of care they give their patients, Dr. Berry says. “It’s 50 percent doing the right thing for the pa- tient and 50 percent knowing rules of the game on how to report. We are here to do the right thing for the patient.” For example, if Dr. Berry treats a diabetic patient but doesn’t document whether the patient takes aspirin be- cause she’s not prescribing it, “that is considered a failure” on that particular quality measure, she says. “Also, the data is old. It’s from 2012, and we can change a lot in a year.” TMA Director of Clinical Advocacy Angelica Ybarra, RN, adds that for some specialties, there are insufficient applica- ble quality measures to report on in the first place, which could unfairly skew the rankings.
Because of these and other shortfalls of quality measurement, “it is critical that the development of a plan for pub- lic reporting of physician performance through Physician Compare recognize
these factors, and for CMS to continue to implement initiatives on a phased-in basis,” AMA’s letter cautions.
And once the quality information is out, physicians question how useful it is to patients.
CMS says stars are consumer-friendly and familiar, and it added the percent- age scores “for full transparency” and to further help patients understand the quality information. Dr. Walters recognizes CMS must find a way to easily communicate the qual- ity information in a way patients un- derstand it but says oversimplifying the results could instead confuse or mislead patients. For example, three versus four stars next to a group practice’s name or an 80-percent versus a 90-percent rank- ing of how well the practice complied with a particular measure may not clear- ly reflect the fact that the care given in both instances is still good care and not dramatically different. Ms. Ybarra says Physician Compare,
coupled with a growing number of com- mercial health plan ranking programs, adds to the confusion for patients who see physicians with different ratings on the different sites. That’s why TMA con- tinues to advocate for consistency across the various programs. Dr. Berry says what patients really want to know is, “Are [the doctors] go- ing to treat me with respect? Are they going to listen? Are they going to follow up with me? And is my care going to be coordinated? That’s much more valuable to patients than what percentage of my diabetes patients use tobacco.” CMS recently began collecting such patient experience data from practices through the Consumer Assessment of Healthcare Providers and Systems sur- vey. Such reporting is optional for now but could become mandatory in the fu- ture. (See “Survey Says …,” March 2014 Texas Medicine, pages 49–53, or visit
www.texmed.org/SurveySays.) Dr. Berry says patients “should have the opportunity to make informed deci- sions, and [Physician Compare] is a step toward that. But we have a long way to go.”
32 TEXAS MEDICINE June 2014
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