How Do Your Providers Rate?

How Do Your Providers Rate?

Before buying something online, you can check reviews from previous purchasers. When you buy a car or appliance, you can check Consumer Reports and other rating services. But when you buy healthcare services, where do you turn for pricing and quality information?

Why Information Matters

High-deductible health plans are supposed to encourage competition by giving consumers financial incentives to seek the most cost-effective, high-quality care providers. HCI3, the nonprofit Health Incentives Improvement Institute Inc., says the U.S. healthcare industry is “ …by and large, completely opaque…. And since fear of market loss is a significant concern for many providers, there has been a tendency to block attempts at greater transparency.”

In most states, you’ll have to look hard to find comprehensive healthcare provider quality information. In HC13’s State Report Card on Transparency of Physician Quality Information, released in December 2013, California received a C, while Minnesota and Washington earned A’s for providing comprehensive physician quality information. All other states received failing grades.

Minnesota residents can thank the state’s 2008 health reform law, which requires the Commissioner of Health to establish a standardized set of quality measures for providers across the state, which resulted in www.minnesotahealthinfo.org. In Washington, consumers can go to www.wacommunitycheckup.org, an initiative of Washington Health Alliance, a nonprofit, nonpartisan organization. Residents in other states have to look a little harder to find physician and hospital quality and pricing information, and comprehensive, easily comparable information might not be available in your area, although more resources are coming online.

Online Health Provider Ratings

A healthcare quality rating might consider a variety of factors, including a provider’s reputation, mortality rates (for specific procedures), accreditation status, surveys and participation in various quality initiatives. Here are some possible sources for quality information:

Aligning Forces for Quality, http://forces4quality.org, works with 16 “alliances” across the country to collect and publicly report data on healthcare quality, cost and patient experience. Sponsored by the Robert Wood Johnson Foundation, AF4Q has alliances in seven metropolitan areas and nine states (including Minnesota and Washington), but many have only limited information available to the public at this point.

Physician Compare, www.medicare.gov/physiciancompare/search.html, is a Centers for Medicare and Medicaid Services (CMS) website that provides consumers with basic information on physicians and other healthcare professionals, including primary and secondary specialties, medical school education and residency information. The site includes Medicare-accepted providers only and limits information on quality to whether a provider participates in Medicare quality programs.However, participation can indicate a provider’s commitment to quality of care.

Hospital Compare, www.medicare.gov/hospitalcompare/search.html, is a consumer-oriented website that provides information on how well hospitals provide recommended care to their patients. As with Physician Compare, it ranks only hospitals that accept Medicare patients, but it can help non-Medicare patients select quality care by providing useful information on how a hospital performs in several important areas, including providing timely and effective care; rates of readmission, complications and death; and how recently discharged patients rate their hospital experience.

ConsumerHealthRatings.com provides no information on its own; instead it offers a comprehensive listing of organizations that rate or report performance on specific hospitals, health plans, physicians, nursing homes, home health agencies and other healthcare providers in the United States. The ratings information is free.

The National Committee for Quality Assurance (www.ncqa.org) is a private, nonprofit organization offering free interactive report cards. The group is governed by a board of directors that includes employers, consumer and labor representatives, health plans, quality experts, policy makers and representatives from organized medicine. For employers, it offers information on health plan quality, efficiency and ratings. (Note that it ranks only NCQA-accredited plans; not all health plans opt to go through the NCQA accreditation process.) Your employees can find listings of physicians whom the NCQA has recognized as meeting important standards of care in certain practice areas. (Lists are very limited at this time.)

The New York State Health Accountability Foundation (www.nyshaf.org) is a public-private partnership dedicated to promoting transparency in the healthcare system and providing employers and consumers in New York and New Jersey with information on hospital pricing and quality.

The state of California’s Office of the Patient Advocate (www.opa.ca.gov/report_card/) provides quality ratings for healthcare plans, hospitals, medical groups and long-term care services, searchable by medical condition, hospital or location.

Consumer Reports, www.consumerreports.org, recently ranked many hospitals nationwide on the quality of their surgical services. The report didn’t consider individual surgeon performance, which can greatly affect patient outcome, but based ratings on the percentage of a hospital’s Medicare patients undergoing scheduled surgery who stayed longer than expected for their procedure or died in the hospital—information that’s publicly available.

In general, we’ve limited this list to governmental or nonprofit sources. Some commercial rating services, such as Angie’s List, use customer feedback to rate physicians and health providers. Patient satisfaction is one, although hardly the most objective, indication of physician quality. Angie’s List is moderated, but others sites, such as Yelp!, are not, so take their ratings with a (large) grain of salt. Other commercial physician “ratings” exist, but most are little more than paid directories.

Health insurers play an important role in promoting quality in health services. They do not want to pay for unneeded care or medical mistakes, so they have incentive to steer plan members toward quality healthcare providers. A good insurance plan will contract with physicians and hospitals that have met accreditation standards. Many health insurers are also taking a leading role in developing outcome based treatment protocols, which promote the use of effective and financially sound treatments.

USI’s strong team of health insurance experts and knowledgeable consultants are available to provide you with more information on managing healthcare cost and quality in your organization.

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