Seven medical groups across Washington state have gone public with their data in 12 clinical performance categories as well as patient-satisfaction scores in five measurement areas as part of a consumer-oriented reporting scheme in partnership with Premera Blue Cross.
For the groups, the public display of the data was something of a leap of faith, according to Scott Baumgartner, M.D., of the 21-member Physician's Clinic of Spokane, a participant in the 2004 Quality Report Card program.
A special section of the Premera Web site went live with the quality reports Thursday morning. Each performance category has its own cover page with explanatory text and links to graphs measuring the performance of each group and in side-by-side comparison with the others. The graphs also have statewide averages calculated from aggregated data gleaned from other unidentified groups across the state.
"We've been doing quality stuff internally for years," said Baumgartner, whose group has been pulling numbers off a Logician electronic medical record system since 1999, but "we have no clue what's going to become of it when it's out in the marketplace.
"I don't think any of us know how it's going to come across," he said, "but we all know we're going to be judged on quality, that consumer-directed healthcare is here and it's going to grow. So we feel it's important."
Other participating groups are Rockwood Clinic in Spokane; Wenatchee Valley Medical Center in Wenatchee; Everett (Wash.) Clinic; and Virginia Mason Medical Center, Pacific Medical Centers and Polyclinic, all in Seattle.
"What a gutsy move by these clinics," said Dave Johnson, M.D., a medical director at Premera who worked as a liaison with the groups on the report card project. "It's easy to share data when it's all good."
But the data collected between June 2001 and June 2002 show considerable variance -- sort of a state-sized Dartmouth Atlas -- with a spread of up to 21 percentage points between the highest- and lowest-scoring groups in one metric -- child wellness visits -- and no less than a 5.9-percentage-point difference between the highest and lowest groups for formulary compliance.
Despite knowing they would be unveiling what Baumgartner called "dirty, unclean laundry," none of the groups backed down.
Johnson said what makes this quality data presentation unique is that the numbers have been gleaned from physicians who are members of preferred provider organizations, the dominant form of insurance coverage in the Pacific Northwest.
"There are many other examples where quality-of-care work is being done, but that's where there was a managed-care population where patients can be attributed to specific physicians," he said. With PPOs, patients have more freedom of choice of providers, so their data is not as easily attributable to a specific physician or group.
The collaboration solved that problem by agreeing on a formula based on the number of patient visits within a specified time for use in data attribution, Johnson said. In fact, collaboration was the key to the whole endeavor, he said. And it didn't come immediately.
"We've been working on this project about three years, from the conception to today. This was really built by the medical groups. From the ground up, they designed the program. We were just a facilitator.
"Initially, of course, they were scared. They said, 'Why should I do this?' " Johnson said.
At first, the data shared among the groups was blinded, so each group saw the variance but didn't know if their group was a leader or a straggler. Then the groups agreed to share group-identified data. The final step was to agree to post each other's data on the Internet for public viewing. That decision came this summer, Johnson said.
"It's out for the world to see," he said. "They're saying it's the right thing to do."
Baumgartner said the commitment to transparency by the groups has fostered cooperation among them to share ways to improve performance.
"We can talk and ask, 'How are you doing that, that it gives you these results, and how can we do ours?' "
Al Fisk, M.D., medical director of 220-physician Everett Clinic, said three years ago, when data sharing began, Everett ranked disappointingly low among the groups in patient satisfaction scores while Polyclinic in nearby Seattle ranked highest.
"I went to them and asked, 'Would you be willing to show me how you did this?'" Fisk said. "I brought that back here and our patient satisfaction level went up 25%. ... Because of this collaborative, I knew who to go to. I went to the best. They were last year, but this year, I'm hoping we are. We've improved a lot."
The sharing of best practices has not been a one-way street.
"Later on when (Polyclinic) wanted to learn on how to be more cost effective prescribing medicine, they learned from us," Fisk said. "I think it's important in the medical world we begin to work toward transparency. I think it's been very successful."