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 in eight medical specialties — from cardiology to pediatrics.
Caqualityratings.org is the latest step in a march toward ever more detailed public disclosure of information meant to convey the quality, timeliness and safety of medical treatments. Hospitals have received the bulk of this independent-assessment attention, but people increasingly want data on the effectiveness of individual doctors' work.
The new website marks the first time in California that major health insurers have aggregated their claims information and worked with a coalition of physicians and others to create a system that begins to measure doctors in every market throughout the state.
The 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, rating doctors' performance on activities such as treating high blood pressure in diabetics and monitoring people on long-term medications.
Each doctor's ratings are determined in relation to the other doctors working in the same specialty, rather than on an absolute scale. So scoring one star out of four means the doctor is in the bottom 25% of comparable doctors — but not that he or she does a bad job.
Doctor ratings have been a thorny subject since websites such as Healthgrades and Vitals emerged, allowing anyone who claims to have received care from any particular physician to post a review of that doctor. That approach has been derided by doctors who say the reviews can be inaccurate, unfair or otherwise misleading.
The new website is an attempt to be more objective about judging the care that physicians deliver.
The new site lists only about 7% of California's 135,375 licensed doctors at the moment, but it does include 25% of those practicing obstetrics and gynecology, internal medicine and pediatrics. About 60% of cardiologists, endocrinologists and nephrologists are listed.
Dr. Ted Mazer, a San Diego otolaryngologist and president-elect of the California Medical Assn., said the association supports the coalition's work on the 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.
Dr. Parag Agnihotri, chairman of the physician advisory group that oversaw creation of the rating system, said physicians who adhere closely 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.
The information underlying the 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 insurers have worked together on the effort for nearly five years. Now participation will be expanded to other insurance companies, such as Kaiser Permanente, Aetna, Cigna and Health Net.
The new ratings system is not a definitive solution to the doctor-rating controversy.
Dr. Ashish Jha, who has pushed 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 ratings system, said all attempts to bring rigor and transparency to healthcare 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.
Although that 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 healthcare buyers, consumers and health providers. It plans to add more categories of measurement to its initial effort in future years.