By Michael L. Millenson
Michael is a contributor to TDWI. He writes extensively on health care issues, and is president of Health Quality advisors LLC.
The launch of Medicare’s Physician Compare website at year-end should have been a watershed event in the long campaign for health care transparency and patient empowerment. Instead – and it pains me to write this – Physician Compare is a case study in how the interests of the average citizen can be shunted aside by indifferent government, lazy journalists and solipsistic special interests. That remains true despite all of those involved being Good People Trying To Do The Right Thing.
By way of background, the Accountable Care Act required the Centers for Medicare & Medicaid Services to make public certain types of provider information by Jan. 1, 2011, a deadline the agency (barely) met. Phase one of the new Physician Compare site is “designed to be consumer friendly and help all patients – whether on Medicare or not – locate health professionals in their communities,” according to CMS.
In reality, the site is confusing and unfriendly to consumers, painfully slow and, worst of all, factually unreliable. Put bluntly, the agency, whose leader famously called himself a “patient-centered … extremist” in a 2009 Health Affairs article, has produced a consumer tool that practically shouts, “We couldn’t care less whether any consumer ever uses this.”
Fortunately for CMS, most of the journalists writing about the site apparently did little more than cut and paste the government press release description of it into their own stories. If I were a federal flack, I’d drink a toast to that famous Marx Brothers movie line: “Who are you going to believe, me or your own eyes?”
The most notable exception was Forbes’ David Whelan. In a biting critique, he wrote that the site “is little more than a directory of doctors and one that, in my basic testing, is missing many entries and slow to load. You’d be better off using a site like HealthGrades or Vitals.com for research since those sites actually list where the doctors trained and in some cases provide richer information like patient reviews, which hospitals the doctors practice at and how good they are, and even malpractice or disciplinary records.”
As for the additional quality information the site pledged to provide, Whelan says he had difficulty finding it or even understanding what it meant. Me, too – and both of us are far more sophisticated users than the average patient.
My experience in getting the site to do the basics it promised was even worse than Whelan’s. After typing in my suburb’s zip code, I’d sometimes receive a list of internists practicing here and sometimes be told there were none. I’d ask for doctors within a one-mile radius and get back a list of more than 500 providers within 15 miles. The site couldn’t even reliably supply physician addresses on the same page as their names. Sometimes it did. Sometimes it didn’t.
CMS did not respond to Whelan about site usability and clarity, but the agency did say it will “begin to implement” in 2012 a plan for making available more comprehensive quality and patient experience data. This information will start appearing by Jan. 1, 2013. Both dates are required by statute. I’ll tell my 89-year-old father to mark his calendar.
Perversely, Physician Compare’s ineffectuality probably protects it from provider ire. Based on past experience in places like the state of New York, a tool that prompts patients to start differentiating among doctors based on clinical criteria could create a political firestorm the Medicare agency is ill-equipped to handle. As it is, physician groups want the government to let doctors correct information. And, in regard to such clinical outcome rankings, these groups also want to ensure there is “adequate” adjustment for patients’ medical conditions before treatment (otherwise known as, the my-patients-are-sicker factor).
Meanwhile, future-focused consumer advocates seem to be giving CMS a free pass on its current failure to provide a basic, reliable and usable tool. In a Perspective piece for the California HealthCare Foundation, David Lansky of the Pacific Business Group on Health and Steven Findlay of Consumers Union gloss over the present in favor of a detailed blueprint showing how Physician Compare could be a “game changer for consumers” if only the government “is bold, decisive and innovative.”
But are those hopes realistic? The health law notwithstanding, the Physician Compare experience suggests the public might be better served in some instances if government provides data while the private sector analyzes it and presents it electronically. “Private sector” is a term that also includes non-profits. After all, as the leader of the Foundation for Accountability, Lansky pushed the envelope on transparency. Findlay has helped do the same at Consumers Union. Depending on the political views of the president appointing the CMS director in 2013, I might prefer a Lansky or Findlay exercising more control over health care information than the U.S. government.
As government regulators, journalists and consumer advocates are fond of reminding doctors and hospitals in a different context, good intentions don’t excuse bad results. In a recent survey, two-thirds of adults said they’d like access to more comprehensive information about doctors. Medicare should fix Physician Compare today and learn from its mistakes to make systematic improvements for tomorrow.