It sounds like a stretch, but someday physician quality scores could be as familiar to the American public as batting averages.
That's the view of Arnold Milstein, M.D., medical director of the Pacific Business Group on Health, which is about to release what industry observers believe is the first consumer survey of physician group quality.
The development highlights a key aspect of the physician-delegation phenomenon: As physician groups assume responsibility for quality and cost, payers want accountability.
The Physician Value Check Survey covers 56 medical groups in California, Oregon and Washington. The Seal Beach, Calif.-based Medical Quality Commission, a not-for-profit organization that accredits physician groups, is a co-sponsor.
The expected cost of about $1 million in the first three years is being borne by pharmaceutical companies, private foundations and medical groups, says Cheryl Damberg, the PBGH's director of quality.
"The overall objective is to make quality count in the healthcare marketplace," says Milstein, who is also a managing director at William Mercer. "In California, with the exception of Kaiser, all of the HMOs are contracting with the same medical groups, so the probability of there being quality-of-care differences at the HMO level is exceedingly low."
Physician Value Check is among several efforts under way this year that promise to help consumers judge physician quality, from the American Medical Association's American Medical Accreditation Program to Oxford Health Plans' initiative to issue quality report cards on specialty networks.
Some physician groups welcome a chance to compete on a basis other than price, but the survey is far from perfect. At the annual meeting of the American Medical Group Association last month in Palm Springs, Calif., some said it focused too much on procedures rather than outcomes.
A sample of 1,000 managed-care enrollees from each medical group was surveyed in 1996 about care received in the previous year, with the emphasis on 50- to 70-year-olds, whose health status tends to change rapidly.
The four-page questionnaire has 66 items, such as "How long do you usually have to wait to see the doctor when you have an appointment?" and "Have you ever had your blood cholesterol checked?"
"Because we have no technology base, we're having to rely on a patient survey as our means of evidence, and people's ability to remember is not perfect," Milstein says.
Patients will be surveyed every two years to assess changes in health and functional status, satisfaction with care and the receipt of preventive and chronic-care services. But survey instruments need to be more sensitive, Milstein says.
"For example, if a person is on a golf course and gets struck by lightning, it's not the delivery system's fault," he says.
Small groups at the AMGA thought they might be at a disadvantage because they cannot afford such programs as diabetes management.
"I think it's going to force a lot of consolidation of smaller groups," says Cliff Ossorio, M.D., chief medical officer at UniMed, an affiliate of Burbank, Calif.-based UniHealth.
Such concerns probably won't swing with large employers, who are struggling to measure value.
The PBGH would like to measure the performance of individual physicians, but that won't be feasible until better technology is in place, Milstein says. In the meantime, programs such as the AMA's AMAP, which is meant to give a seal of approval to physicians who meet certain quality criteria, may have to suffice in markets where physicians are not bundled conveniently into large groups.
Results were released to Southern California groups late last month and will be shown to others this month, followed by a public release around late August.