On finding an objective way to cherry-pick the best doctors and hospitals.
Choosing a physician or a hospital based on publicly available performance measures can be overwhelming and confusing, and may result in decisions that rely upon personal recommendations or proximity rather than genuine quality. Reams of presumably objective data are available: The Agency for Healthcare Research and Quality, the Joint Commission, the Leapfrog Group, and Consumer Reports—as well as most states and for-profit companies such as Healthgrades and U.S. News & World Report—offer various ratings, rankings, and report cards. Hospitals even generate their own measures and post their performance online, although in many cases without authenticating their methodology or data.
The value and validity of these measures vary greatly. Even when methodologies are transparent, clinicians, insurers, government agencies, and others frequently disagree on whether a rating accurately indicates the quality of care. For example, The Johns Hopkins Hospital was both congratulated and criticized for its performance on central line-associated bloodstream infections by two Maryland agencies during the same time period because each used a different methodology.
For healthcare consumers, making sense of this can be difficult, especially with a lack of expert consensus. There are steps one can take, such as checking online to see if a doctor is board-certified (a basic requirement) or assessing a surgeon’s experience (10,000 hours is often used as the gold standard).
One possible solution that could help consumers better navigate this complex marketplace in the future is the creation of a healthcare equivalent of the U.S. Securities and Exchange Commission (SEC), minus the regulatory role. Rather than wading through a thicket of competing and often contradictory performance measures, patients and others would have one source of quality data that has national consensus and validity behind it.
Under this model, this entity would partner with private-sector institutions to set rules for the development of measures and the transparent reporting of their performance, analyze progress, and audit publicly reported measurements of quality. Private-sector information brokers could then conduct secondary analyses of the reports, as happens in the financial industry through companies like Bloomberg. This SEC-like model could thus ensure that all publicly reported quality data are generated from a shared basis in fact and allow apples-to-apples comparisons across provider organizations.
Before the SEC was created, in the aftermath of the Wall Street Crash of 1929, information provided by one business typically could not be compared to that of another, as there were no common standards for reporting financial performance. More than 80 years have passed since then, and healthcare is mired in a similar situation despite great efforts to drive improvement and inform patients’ decisions. A collective entity could benefit healthcare consumers, providers, and payers alike. It would stimulate innovation in developing, analyzing, and reporting measures while ensuring all those involved work from a common book of truth.