On one hand, payers and government are pushing hard to make physician-specific performance data available to the public -- for many admirable reasons, among them improving physician accountability and patient safety.
On the other hand, many doctors don't like it a bit, often for good cause.
According to a Commonwealth Fund study, 69% of physicians in a national survey were opposed to sharing physician-specific performance data with the general public. Forty-four percent expressed reticence at sharing individual performance data with their own patients, and 27% were hesitant to share it with medical leadership.
"If you scratch the surface and ask why docs don't want to share the data, they have good reasons," said Stephen Schoenbaum, M.D., co-author of the study and executive vice president for programs at the Commonwealth Fund.
"If you go to some of the rationalizations, they'll say there are only a handful of these measures that can be applied to my practice, so they only tell a part of the story," Schoenbaum said. "And there is some truth to that. Even if you have a really good set of measures, you're only measuring a percentage of what the physician is doing."
Physicians don't want to be judged as if the data set were the sole measure of their work, he said.
Still, the perfect should not be the enemy of the good, said Schoenbaum, who supports disclosing physician-specific data. "You are measuring a percentage, so why shouldn't that information be made available?" he asked.
Few physicians have access to practice-level performance data themselves, according to the Commonwealth Fund study, published in the May/June issue of Health Affairs. The study was based on a 2003 survey of 3,598 physicians.
For example, 49% of physician respondents said they could easily or somewhat easily generate a list of patients by age group. Forty-four percent could do so by diagnosis, 16% by laboratory test result, and 15% by medication.
Twenty-five percent of the physicians said they could obtain patient survey results. Twenty percent could calculate the percentage of their male patients age 50 and older who had received prostate examinations. And 18% could identify the percentage of their patients with good glycemic control.
"I wasn't shocked by the numbers," Schoenbaum said. "My shock was in the attitudes. Even though I could rationalize some of it away, the resistance I found was shocking. I think there is a real disassociation between what makes sense at the patient's perspective and where the docs have put their feet down."
Payers were the most common source of quality data. Just 13% of physicians reported generating quality data from their own sources, perhaps partly because three-fourths of the respondents did not use an electronic medical record.
"If you had your own stuff, which probably does require better systems in one's practice, then, at least you'd have it on your entire practice," Schoenbaum said. "The data that you get from an insurer is always on patients from just a part of your practice, because no one insurer insures all your practice. So you can ask, how valid is that data?"
The survey indicated, as others have done, that a digital divide is opening based on practice size. The smaller the office, the less likely a physician had access to practice-level quality data.
One way to mitigate the problem is to make IT more accessible to the smaller offices by having insurers pick up some of the costs.
Schoenbaum pointed to the Integrated Healthcare Association in California as a milestone. The association, a pay-for-performance project in which quality data is shared, involves six health plans and more than 200 medical groups. Part of the payments made under the program reward practices for investment in IT.
"Groups looking at this are looking ahead," Schoenbaum said. "They're ones who have at least seen where the future is, and they're starting to show you it can be done."
