Doctor Quality Data Unuseful to Consumers

Consumers searching this fall for the best doctor covered by their new public or private insurance plan won’t get very far on a federal database designed to rate physician quality.

The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It’s so limited, health care experts say, as to be useless to many consumers.

This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament.

A report out last week by the Georgetown University Health Policy Institute said insurers were limiting the choices of doctors and hospitals for those buying insurance on health insurance exchanges to keep premiums low.

The CMS data include only 66 group practices and 141 accountable care organizations (ACOs). There are about 600,000 doctors in the USA, tens of thousands of group practices and more than 600 ACOs, which are partnerships between doctors and hospitals to treat a group of patients efficiently.

The database lists just five areas of doctors’ effectiveness in treating diabetes and heart disease. These include whether doctors prescribed aspirin and how well they controlled diabetics’ blood pressure.

“They are behind, there’s no doubt,” says Terry Ketchersid, a kidney physician and vice president of clinical health information management for the electronic health records company Acumen.

“The goal of these sites is for the average Medicare beneficiary to go out and make an intelligent choice,” he says, but only another doctor would understand what to make of the ratings.

The CMS plans to add more quality measures and patient experience data for ACOs this year, spokesman Aaron Albright says. He says the CMS uses a “phased approach for public reporting to make sure the data are accurate and the measures reported help consumers make informed health care decisions.”

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary