In August, the Medical Group Management Association released the results of its annual survey of its members on issues that challenge them most in their professional lives. In this edition of Practice Makes Perfect, we address No. 15 on the list: Understanding physician rating criteria.
To answer this question, you first need to know who is monitoring and rating physician performance. Organizations rating physician performance seem to fall into two broad categories: healthcare insurance companies (payers) and a variety of other organizations reporting on their Web sites.
Payers have developed a number of proprietary rating systems that are primarily based on claims analysis. Some payers are willing to discuss the details of their methodology and others are not. They generally state that their ratings are based on some combination of objective (clinical) and subjective (patient satisfaction) criteria. Many of us also suspect that the cost of the care provided by the physician is also factored in.
It is recommended that physicians become familiar with their payers' quality rating systems. You should identify which payers are providing ratings, and then get access to the ratings. Follow up and request detailed information on how the ratings are developed. Finally, be prepared to challenge and appeal ratings that you don't agree with. Experience has shown that the reporting of inaccurate data is not infrequent. Some states, such as Colorado, have established regulations and set standards to be followed by payers.
Dealing with other organizations on the Internet who report on physician quality is more problematic. Do a Google search of the words “physician ratings” and see the list of organizations providing consumers with information. Last time I looked I found at least two dozen organizations providing information. Some organizations focus on physicians and others provide a wide variety of information and physicians are only a subset of other lists. In many cases this information is fairly superficial and developed from sometimes anonymous patient input. Unfortunately, dissatisfied patients are more likely to provide input than satisfied patients.
I would recommend that these nonpayer physician rating sites be occasionally monitored to see what is being said. They could point to some changes that should be made within your practice.
Statistically it has been reported that while some patients view Internet ratings, they also weigh a variety of other factors that you have much more control over. Most patients obtain references from friends and neighbors.
Be prepared to address questions from patients regarding ratings if asked. One practice we worked with actually prepared a brochure to hand to patients addressing issues related to various quality rating systems and stated the practice is proactive in addressing quality and patient-satisfaction issues on its own. If your practice is proactive, these ratings sites could actually work in your favor.
Jeffrey MilburnIndependent consultantMGMA Health Care Consulting GroupEnglewood, Colo.
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