How does your doctor rank? Check out this new website

Independent efforts to assess individual doctors remain controversial.

San Diego Union-Tribune

March 28, 2017 6 AM PT

An unprecedented statewide website takes aim at one of the most fraught issues in medicine: Rating the performance of individual doctors.

Newly launched by the California Healthcare Performance Information System, the site scores 10,000 doctors in California, providing ratings of one to four stars in eight medical specialties — from cardiology to pediatrics.

Caqualityratings.org is the latest step in a long-running march toward ever-more-detailed public disclosure of information designed to convey the quality, timeliness and safety of treatments that patients receive. Hospitals have received the bulk of this independent-assessment attention through the work of outside evaluation organizations and even the federal government, but doctors are facing a growing consumer demand for more data to show the effectiveness of their work.

The new website is the first time in California that major health insurance companies have aggregated their claims information and worked together with a coalition of physicians and others to create a system that begins to measure physicians in every market up and down the state.

Dr. Parag Agnihotri, chair of the physician advisory group that oversaw creation of the star-rating system, said he believes the information can help patients gauge health-care quality.

“This is a tool for consumers so they can make sure they’re getting the care they deserve,” said Agnihotri, medical director of the Sharp Rees-Stealy Medical Group.

The star ratings don’t tell the public definitively whether one doctor is better than another at treating certain ailments. They focus on certain “process of care” measurements, assigning a number of stars to factors such as treating high blood pressure in diabetics and monitoring people on long-term medications.

Doctor ratings have been a thorny subject since websites such has healthgrades.com and vitals.com emerged, allowing anyone who has received care from any particular physician to post a review under that doctor’s name.

The approach has been derided by doctors who say the reviews can be inaccurate, unfair or otherwise misleading. Caqualityratings.org is an attempt to be more objective about judging the care that physicians deliver.

The new site lists only about 7 percent of California’s 135,375 licensed doctors at the moment, but it does include 25 percent of those practicing obstetrics and gynecology, internal medicine and pediatrics. Approximately 60 percent of cardiologists, endocrinologists and nephrologists are listed.

Dr. Ted Mazer, a San Diego otolaryngologist and president-elect of the California Medical Association, said the association supports the coalition’s work on the star-ratings system, but would have preferred a more complete set of information that tried to take into account patients’ compliance or lack of follow-through.

He cited the example of a colleague’s recent patient who stopped for an order of french fries on the way to a local emergency room for urgent treatment of congestive heart failure.

“The data we use in these kinds of systems has to be accurate and tempered by whether or not patients followed the course of treatment that was advised for them,” Mazer said.

Each doctor’s star ratings on the new website are determined in relation to the performance of other doctors working in the same specialty, so no one is getting a low number of stars on an absolute scale.

While Agnihotri said it’s true that patient compliance with doctors’ requests is a factor, the fact remains that physicians with close adherence to the standards used to build the new site’s scoring system show a higher level of dedication to helping patients prevent illnesses.

The best doctors, he said, spend more time checking whether their patients are taking prescribed medications and devote more energy to explaining why preventive screenings are necessary.

“We’re saying, ‘Let’s try to get to those patients who are sitting on the fence and we can engage them,’” Agnihotri said.

The information underlying the star ratings came from claims data provided by Medicare and three of the state’s largest health insurance companies: Anthem Blue Cross of California, Blue Shield of California and United Healthcare of California.

Those three insurance companies have worked together on the effort for nearly five years. Now that the first set of ratings has been posted, participation will be expanded to other insurance companies such as Kaiser Permanente, Aetna, Cigna and Health Net.

Some experts said while they respect the new ratings system, and especially its ability to harvest details from insurance companies that have historically been loathe to work together, it hardly provides the final solution to the doctor-rating controversy.

Dr. Ashish Jha, who has pushed relentlessly for better quality measurements and public transparency at all levels of the health industry, said the items included are quite narrow and don’t, on their own, paint a full picture of which doctors are the best in any given market.

“I’m not claiming I could do much better. It’s hard. This is part of an ongoing effort,” said Jha, director of the Harvard Global Health Institute. “This data is useful maybe at the extremes, the one stars and the four stars. But I wouldn’t put a lot of stock in this. I would use it as one data point among many when trying to pick a doctor.”

Dr. Helen Burstin, chief scientific officer at the National Quality Forum, a nonprofit organization that endorses quality measures including those used by the new rating system, said all attempts to bring rigor and transparency to health-care ratings should be applauded.

“We want valid information presented to patients in ways that they can understand,” Burstin said. “I think taking standardized measures like this and using them is useful.”

But, she added, the trend is toward using information on patient “outcomes” — such as how patients rate specific aspects of their care experience, the timeliness of care and overall mortality rates — to bring greater clarity to a doctor’s performance.

While this kind of information is already widely used today to gauge the quality of hospitals, and in some cases large doctor groups, applying the same calculations to individual doctors can be difficult, Jha and Burstin said.

“A doctor might see 100 or 200 diabetes patients in a month, whereas a hospital might see 1,000 in the same amount of time. Statistically, that makes it more difficult to say something useful for doctors when you have a much smaller sample size,” Jha said.

The California Healthcare Performance Information System is a nonprofit group that includes health-care buyers, consumers and health providers. It plans to add more categories of measurement to its initial effort in future years.

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