Every patient has a right to know about his or her clinician’s expertise and outcomes.
Online scoring systems are available that attempt to rate clinicians’ expertise and outcomes. These include Medicare’s Physician Compare (www.medicare.gov/physiciancompare/search.html), Consumers’ Checkbook’s Surgeon Ratings (www.checkbook.org/surgeonratings), and Propublica’s Surgeon Scorecard (projects.propublica.org/surgeons). Physician Compare has basic information about a physician’s qualifications and some clinical outcomes information (like how many patients in a clinician’s practice have good diabetes control). Consumers’ Checkbook and ProPublica attempt to display how often patients have complications after their operations. These systems try to identify clinicians who have acceptable results or rank them as being better or worse than average, but in the current format, these rating systems have significant limitations that make them of uncertain value for patients.
Physician Compare provides information about clinicians who provide care for Medicare patients (which is most US physicians). Most of this is objective information and provided by clinicians themselves, so it is generally accurate. The other rating systems that attempt to provide individual clinician complication rates have issues limiting the utility of the rating systems. First, there are typically delays of greater than 1 to 2 years in the clinical outcomes data appearing in the scoring system. Second, not all of the metrics used to assess clinicians are universally accepted as valid measures of a clinician’s outcomes. Both the Consumers’ Checkbook and ProPublica scoring systems rely on data collected from the system doctors and hospitals use for billing Medicare. Because the data are intended for billing and not measuring clinical outcomes, important information about a patient’s clinical condition may be missing, important complications may not be identified, and the data generally pertain only to patients older than 65 years. Third, Consumers’ Checkbook and ProPublica are private agencies and have no public accountability if they make mistakes. They are not required to validate their metrics prior to publication. Fourth, some of the reported complications may not be caused by the clinicians in the database. The complications may be caused by other clinicians or problems with the hospital itself but are assigned to the clinicians because of incomplete or inaccurate information. Fifth, the rating systems are not fully risk adjusted (a risk-adjusted score accounts for a clinician’s taking on high-risk patients, problems, or surgeries). Clinicians who take care of sicker patients will have more complications, so risk adjustment attempts to level the playing field. Unfortunately, because of limitations in the data source used for these scoring systems, the risk-adjustment calculations cannot completely account for all the risks involved in delivering clinical care.
The available physician scoring tools may not yet be reliable enough to be used as a basis for decision making when selecting a clinician. The information they contain is incomplete and likely sometimes inaccurate. The ratings can serve as the basis to initiate a conversation with a clinician. One approach to selecting a clinician is to ask other clinicians (such as your primary care clinician) what their experiences have been with that clinician and with patients the clinician took care of. When seeing the clinician you are considering getting treatment from, feel free to ask questions such as: How necessary is the treatment that is recommended for me? What are the alternatives to the proposed treatment? What are the clinician’s and hospital’s experience and expertise in providing the proposed treatment? How often do they perform the treatment? How are complications monitored, and what is done to ensure the best result possible? How will I be cared for after I get the treatment?
American College of Surgeonswww.facs.org/education/patient-education
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab. A Patient Page on what to ask your surgeon before an operation was published in the February 3, 2015, issue of JAMA and provides more detailed questions to ask before considering having surgery.
Sources: Centers for Medicare & Medicaid Services
Wei S, Pierce O, Allen M. Surgeon Scorecard. New York, NY: ProPublica; July 14, 2015.
Topic: Patient Safety
Razmaria AA, Livingston EH. How to Use Online Clinician Rating Systems. JAMA. 2015;314(13):1418. doi:10.1001/jama.2015.11957