The trend toward issuing report cards on the nation's hospitals and doctors has not been shown to improve care, and might even harm patients, some physicians warn.
In a critique published Wednesday in the Journal of the American Medical Association, two doctors cite a 1997 survey that found many surgeons reject some sicker patients for fear of hurting their report card grades.
Medicare began requiring hospitals to report data on 10 quality measures last year and posts the information on the Internet. It now plans to start rewarding better-performing hospitals and doctors with more money.
Similarly, the consumer group Consumers Union is pushing states to require hospitals to report infection rates. Four states -- Illinois, Florida, Missouri and Pennsylvania -- already have such laws.
"I don't want to come across as being against quality improvement, but we need more empirical evidence before we launch the universal projects that people are talking about," said Rachel Werner, M.D., of the Philadelphia Veterans Affairs Medical Center, who wrote the critique with colleague David Asch, M.D.
After New York state began reporting doctors' patient death rates, those death rates dropped. But in the 1997 survey of 104 heart surgeons, two-thirds said they had selected healthier patients for surgery and rejected sicker patients to keep their scores high, Werner and Asch said.
They also cited a study showing some VA hospitals got poor grades despite treating patients appropriately.
Marvin Lipman, M.D., medical adviser to Consumers Union, said patients deserve to know how well their hospitals and physicians perform.
"If I'm going for a belly operation to a hospital with a lousy infection rate, I want to know that," he said.