More on report cards

March 9, 2005

Consequences of Physician Report Cards – reports on an article in this week’s JAMA. I have discussed this issue in previous rants. The AP report on this article appears here – Debate Grows Over Grading of Doctors

The trend toward issuing “report cards” on the nation’s hospitals and doctors has not been shown to improve care, and might even harm patients, some physicians warn.

In a critique published Wednesday in the Journal of the American Medical Association (news – web sites), two doctors cite a 1997 survey that found many surgeons reject some sicker patients for fear of hurting their report card grades.

Medicare began requiring hospitals to report data on 10 quality measures last year and posts the information on the Internet. It now plans to start rewarding better-performing hospitals and doctors with more money.

Similarly, the consumer group Consumers Union is pushing states to require hospitals to report infection rates. Four states — Illinois, Pennsylvania, Florida and Missouri — already have such laws.

“I don’t want to come across as being against quality improvement, but we need more empirical evidence before we launch the universal projects that people are talking about,” said Dr. Rachel Werner of the Philadelphia Veterans Affairs Medical Center, who wrote the critique with colleague Dr. David Asch.

After New York state started reporting doctors’ patient death rates, those death rates dropped. But in the 1997 survey of 104 heart surgeons, two-thirds said they had selected healthier patients for surgery and rejected sicker patients to keep their scores high, Werner and Asch said.

They also cited a study showing some VA hospitals got poor grades despite treating patients appropriately.

Dr. Marvin Lipman, medical adviser to Consumers Union, said patients deserve to know how well their hospitals and physicians perform.

“If I’m going for a belly operation to a hospital with a lousy infection rate, I want to know that,” he said.

As scientists we know that all hypotheses need testing. Good studies often change our opinions. 5 years ago, we enthusiastically recommended hormone replacement therapy for post-menopausal women to prevent cardiac disease. Now we avoid HRT for the same reason!

Even ideas that sound good require testing. Physician report cards should be held to the same standard as other issues in health care. They may improve care, but the may harm overall care

I discussed this issue in some depth last week – Concern over pay for performance

Related Posts

1. More caution on report cards
2. What should our report cards look like?
3. Another article on patient report cards
4. The danger of public report cards
5. DrRich nails physician report cards

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Posted in General, Medical Rants