Online reviews, quality ratings and price comparisons are commonplace for people shopping for everything from restaurants to cars.
Before long, experts say health care consumers could have easy access to similar information about doctors and hospitals, as the government and private insurers seek to empower patients to drive the medical industry to improve quality and reduce costs.
“There’s very slow uptake on this,” said Donald Fischer, chief medical officer for Highmark Inc., the state’s largest health insurer.
“But more and more, you’re going to see this information on websites. … I think it’s going to explode as we get better tools.”
Highmark offers online star ratings of doctors in its network, ratings that are generated by patients. But Fischer said few patients submit feedback. And it’s unclear if ratings affect patient choice.
Even doctors — once perceived as putting up roadblocks to public reporting of quality measures and patient reviews — are beginning to accept the need for more transparency, as long as it’s accurate and fair, said Dr. Kevin Garrett, president of the Allegheny County Medical Society and a surgeon at UPMC Passavant.
“I do support all of the valid programs that are out there, whose primary aim is to improve processes and outcomes,” Garrett said. “We’re long overdue to have the tools” that enable physicians to see where they need to improve.
But those tools need to reflect the complexity of delivering medical services and not penalize doctors for events beyond their control, he said.
For example, Garrett said, surveys to gauge patients’ experiences with doctors include measures of waiting-room times and time spent with physicians. If doctors focus on reducing wait times, it could lead to them not spending enough time with patients.
“It’s a tough balance,” he said. “You push in on one side and it comes out on the other side.”
So far, surveys and quality data are used internally only at UPMC and other hospital systems.
But it’s agreed that patients, pushed to become more involved in medical decisions through the growing prevalence of high-deductible health plans, soon will be able to access the information.
“Under the Affordable Care Act, there’s a greater expectation that these measures will be robust and available … because consumers are more involved,” said Betsy Imholz, a director of health care projects for Consumers Union in San Francisco, a nonprofit that publishes Consumer Reports magazine.
The government uses hospital quality ratings in limited ways to set reimbursement rates. Hospitals can be penalized for not reducing rates of preventable readmissions, for example, Imholz said. The Centers for Medicare & Medicaid Services posts quality ratings for hospitals on specific procedures.
Garrett believes patients primarily rely on the advice of primary care physicians or family members when choosing other doctors, such as specialists.
“Most of my referrals come from trusted primary care doctors,” he said.
In addition to posting patient ratings, Fischer said Highmark would like to include on the website quality measurements for doctors, such as infection rates, he said.
The insurer provides an online cost estimator for dozens of common procedures and tests. Members can log on to Highmark’s website, search a specific procedure, and get an estimated cost from all providers in Highmark’s network. Other insurers are offering similar website functions.
The goal of such transparency would be to raise quality of care by steering patients to high-value doctors — those who provide quality and the best price, Fischer said. Performance wouldn’t need to be linked to payment, he said, because underperformers would lose business and, theoretically, stop practicing.
“Just having it out there alone fosters improvement,” Imholz said. “Nobody wants to look bad on their report cards, especially when they’re used to getting A’s in school.”
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