doctor shopping


Counterpoint: Medicare Data Flood Useful, Just Not To Average Patient Yet

Source: Dr. Farzad Mostashari, Engelberg Center for Health Care Reform, The Brookings Institution

Source: Dr. Farzad Mostashari, Engelberg Center for Health Care Reform, The Brookings Institution

For a moment there, it looked like a point-counterpoint clash of health-policy views, based on this post: Deluge of Medicare data: Is it useful? Well it’s a step.

Dr. Darshak Sanghavi, a distinguished Massachusetts-based doctor/author who is now a fellow at the Engelberg Center for Health Care Reform at the Brookings Institution, tweeted that he was “not on board with that view.” (The view that the great recent gush of Medicare data is not very useful. At this point, anyway.)

Turns out, though, that Dr. Sanghavi is quite willing to stipulate that, as he put it when we spoke today, “It is highly unlikely that the average patient can do much with Excel spreadsheets containing millions of line items with medical codes.” So from the patient’s point of view — our usual CommonHealth vantage point — he agrees.

But he adds a big “however.”

“However, having said that, I think part of the challenge now is: What should people who have data-crunching skills — whether private industry, regulators, government officials and others — now that the data is out there, what business case can be made for them to do that work for you?”

“I think the key consumer here is not the patient — tens of millions of spreadsheet entries are not going to be valuable to patients. But this is exceedingly valuable to insurers now. Insurers know what their claims are now, but there’s a very competitive insurance marketplace. As an insurer you only know, say, your 5 or 10 percent of the market, but now that you have Medicare data, you can say, ‘That’s really weird. On Medicare patients, they’re only doing steroid injections on one patient out of 10 or whatever, whereas on my covered patients, they’re doing it on 50 percent. Why is that? Is it because I’m paying a different rate than Medicare? Are my incentives screwed up? Should I be rethinking how I do pricing and contracting? Or is there some really good reason?’ You can see what is price-sensitive behavior on the part of providers in a way you couldn’t see before. So that’s very valuable, if you’re a private insurer.

“Now suppose you’re a public health researcher. Continue reading

Study: A Few Bad Apples Dominate Patient Complaints About Doctors

(Wikimedia Commons)

(Wikimedia Commons)

It’s tricky. Patients want to be able to shop for high-quality doctors — or at least avoid the bad ones — but the quality information they can access remains spotty at best, even in these days of Yelp and Angie’s List.

Here in Massachusetts, we also have the Massachusetts Health Quality Partners, which gather data on patient experience — as featured recently in the Consumer Reports ratings of physician practices in the state. But a recent Health Business Blog tour of the existing quality-shopping resources found it still coming up so short that the headline is “The still-early state of online doctor reviews.”

Of course, if we could all know more about the official complaints against doctors and hospitals — and not just the tiny trickle that end up being made public — that would certainly help. So here’s an interesting idea just out from the journal BMJ Quality and Safety: What if the first three complaints about a doctor could be kept confidential, but once the fourth rolled in, the patient concerns had to be made public?

Doctors named in a third complaint had a 38% chance of being named in another one within one year.

Here’s the rationale: a new study of Australian doctors found a striking phenomenon of “frequent fliers”: “Half of all formal patient complaints made in Australia to health ombudsmen concern just 3% of the country’s doctors, with 1% accounting for a quarter of all complaints,” it found.

Wouldn’t you love to know exactly which doctors comprise that 1 percent, especially when you’re in the market for a new one?
From the press release:

Doctors complained about more than three times are highly likely to be the subject of a further complaint – and often within a couple of years – the findings show.

The problem is unlikely to be confined to Australia, warn commentators, who point out that while regulators often know about these problem doctors, patients usually don’t.

The researchers base their findings on a national sample of almost 19,000 formal patient complaints filed against 11,148 doctors with health service ombudsmen (commissions) across Australia between 2000 and 2011.

Over 60% (61%) of the complaints concerned clinical aspects of care, while almost one in four (23%) concerned communication issues, including the doctor’s attitude and the quality or quantity of information provided.

Most (79%) of the doctors involved in complaints were men, and over half of all those complained about (54%) were aged between 36 and 55.

When the distribution of complaints was analysed across all doctors in practice, this showed that 3% of practitioners accounted for 49% of all complaints made; and 1% accounted for a quarter. Continue reading