It doesn't matter how much healthcare providers and researchers rail about the inadequacy and inconsistency of the consumer ratings offered by the CMS, the Leapfrog Group, journalism outfits and online startups. They are not only here to stay, they are proliferating.
Last week, Yelp, best known for its consumer reviews of restaurants, teamed up with ProPublica, a not-for-profit investigative journalism group, to rate nursing homes. It's the first of what promises to be a series of partnerships linking hard data to consumer ratings in healthcare.
On Yelp's newest online tool, if an elderly person or family member searches for nursing homes by ZIP code or city, not only can they read individual consumer reviews about their experiences, they also can get instantaneous readouts of the homes' histories of receiving excessive fines or whether they had ever been suspended for poor performance by the CMS. They can even read each home's biannual inspections reports.
That came less than a month after ProPublica stirred outrage among the nation's surgeons by releasing an independent analysis of Medicare-derived data on 16,810 surgeons. The group's online search tool allows consumers to look up how many times each surgeon performed one or more of eight common procedures; how many complications occurred; and where that surgeon's complication rate ranked on a national scale.
Over the next few months, you can expect articles in medical and health policy literature blasting ProPublica's focus on the limited data of individual surgeons without adequate risk adjustment. “It goes against everything we're trying to do in the patient-safety movement,” lamented one surgeon, who focuses on improving the systems within which surgeons operate.
Memo to hospital officials, physicians and other providers: Consumers and patients don't read the scientific and policy literature.
On the other hand, they do visit Yelp, U.S. News & World Report, Consumer Reports, HealthGrades and other websites betting big that consumer-driven medicine is the new new thing in healthcare, especially now that more people are being thrown into high-deductible plans.
The touchstone for most of the data used in ratings systems resides at the CMS, which during the Obama years has become much more transparent. The agency has also led the way in establishing consumer-friendly star- rating systems for hospitals, dialysis clinics and nursing homes.
Providers are pushing back on a number of fronts. They're taking aim at the failure of readmissions penalties—a metric commonly used by the raters—to take into account the social factors that lead to poor outcomes on that measure.
A recent study in Health Affairs, whose authors included some of the most noted safety experts in the country, lambasted the ratings organizations for the discordant messages they send to consumers and hospital officials. Few hospitals rated as top in one survey made a similar grade in another. “For hospital leadership, differences across rating systems complicate decisions regarding the focus of their improvement efforts,” they argued.
The rating groups fired back that they are measuring different things. Some look at safety; others evaluate specific service lines.
In any case, one must take hospitals' complaints with a grain of salt given their marketing departments' willingness to ballyhoo a “top-ranked” rating with newspaper ads, billboards and radio spots. And as far as improvement focus is concerned, that's why leaders in the C-suite are paid the big bucks.
Given that consumer-focused star ratings and data dashboards are here to stay, there are some things that providers can legitimately insist on from raters.
First, anybody who publishes ratings aimed at the public ought to be transparent about the subcategory data that goes into an overarching rating, whether it's a letter grade, a “top” rating or a numerical score. Publishing impenetrable methodology papers isn't enough.
Second, industry standard setters need to come up with a common set of measures of processes and outcomes that researchers agree determine quality and safety in each field and institutional setting. They should create an infrastructure that can adjust those measures rapidly as knowledge about what works best evolves. And they need to insist that every provider routinely reports on those measures.
If they think what the CMS is penalizing is wrong, then the solution is to come up with something better—not slow the process or roll back the rewards and penalties that now exist without substituting anything. That will only lead to more Yelps.
