Thursday, March 10, 2011

Cars, planes, and trains. And later, there are the doctors.

I have great admiration for the Massachusetts Health Quality Partners. The mission is sound, and the organization uses what exists to good purpose.

But this post is about what exists, and it is not good enough. MHQP just published its annual review of primary care practices in the state, available here. You would like to think that you could use the information provided to conduct a comparative review of your MD's practice group compared to others, looking at compliance with generally accepted guidelines.

But you can't. Why not? Because the data are old.

If you review the report's technical appendix, you find that "This report provides information on the 2009 performance of Massachusetts Medical Groups on the selected HEDIS® Measure Set. ...The measurement periods vary somewhat by measure, but in general, HEDIS® 2010 measures report on performance during calendar year 2009."

What would be really useful is current information.

The data for this report come from the five major Massachusetts health plans. I have heard over and over from these insurers about the advanced information systems they have in place. So why does it take so long to collate rather simple data from that which was collected well over a year ago?

In contrast, let's look at the currency of the auto repair data provided by Consumer Reports. Here's how they do:

All our reliability information is completely updated annually. We begin sending out each year's survey in the spring. By late summer, we have collected and organized responses, and we complete our analysis and update the information online by late October. The new information first appears in print in the Consumer Reports Best & Worst New Cars, on newsstands in mid-November. ...All reliability information we publish is based on subscribers' experiences with cars in the 12-month period immediately preceding the survey.

How about airline on-times rates? Collected monthly, reported within three months. Curious about annual figures on that metric, but also many other quality metrics that might influence your choice of carriers (flights cancellations; chronically delayed flights; causes of delays; mishandled baggage; bumping; incidents involving pets; complaints about service; complaints about treatment of disabled passengers; discrimination complaints? Within two months of the end of the year.

The Boston transit system -- not always viewed as the paragon of efficiency! -- on-time rates? Monthly, published within weeks.

Don't you think we deserve more timely information about the quality of our primary care group than we can get about cars, airplanes, and commuter rail?


Anonymous said...

Paul, the first couple times you decried old data (re transparency on hospital acquired infections, a few years ago, I kind of nodded my head. But recently my former hospital was fined for poor performance on one of these metrics by the state of Md. Their explanation? The data were old, and now they're doing good things. Honestly, this probably will affect the willingness of patients to go to that hospital - now.

So yes, I am finally getting it - there is no excuse for not having current data. Thanks for being out ahead of the crowd once again.


Bill said...

From Facebook:

It is really no surprise. It boils down to 1) vested interests and 2) utility of the information.

Product ratings are the core of Consumer Reports' business, therefore the information is processed efficiently. The MTA has a vested interest in assuring the public that it is doing a good job. The FAA has been pushed by consumer groups to provide information on airline performance. Ratings of autos and airlines are easily used by consumers.

For medical practice performance, no one has built a successful business model to provide quantitative ratings of MDs. Secondly, the utility of this information is limited. It is often trumped by among other reasons office location, membership in an insurance plan, and absence of medical record portability. Lastly, insurance companies and MDs have on vested interest in providing this information.

Barry Carol said...

While MD’s and insurers may have no vested interest in providing the information, regulators do, or at least they should if they want to foster transparency and accountability. I don’t see why hospitals, specialist societies and PCP’s can’t pool their expertise and develop metrics that are relevant and that they themselves would find useful in selecting a provider. I don’t think it’s rocket science. I blame the doctors for a decades long history of trying to stifle competition and transparency at every turn. Regulators need to push this and it wouldn’t even cost much money but it’s not glamorous and it probably won’t have an immediate impact on the medical cost growth trend.

Anonymous said...

My thoughts were similar when I saw these results being trumpeted. More though, was 1. HEDIS data are less interesting to a patient than a health plan (s dr's compliance with some measures can be considered an inconvenience or intrusive by a patient) and 2) great, so the practices in Mass do better than the rest of the country... this isn't news, so now what? Did we learn anything else?

jonmcrawford said...

This is kind of amusing to me, the problem here isn't that doctors or insurance companies don't have a vested interest in this, or that they're doing better/worse than the FAA. Simple reality here is that providers of service do not (typically) pay well for coding/billing personnel, and claims lag is INTERMINABLY SLOW in all too many cases. The majority of claims can and do come in within say three months, but total claims runout to 100% completion can take up to 18 months from the date of service. That's just for the claim to come in the door, folks, not for it to get processed, paid, and *get* to HEDIS, regulatory agencies, etc.

The first step toward fixing (i.e. getting current data) will be to get providers of service to bill timely. EHR, anyone?

As it stands, this IS current data.

Anonymous said...

Paul, I appreciate your wish, but it isn't realistic. As Jon says, this is the MOST current data they have to offer!

Right now health plans are just running the rates for 2010 data (HEDIS 2011).....then, as an adjunct, they have to turn a dataset over to MHQP, and MHQP performs its analysis, aggregating and cutting the data in a different way. Hopefully as EHR takes more of a foothold, the claims lag will lessen, and data from providers will get to the health plans right away...but it will take quite a while (if ever) to get to a point where results can be obtained virtually immediately.

Paul Levy said...

Oh please, enough excuses. Instead of waiting for a calendar year's closing, the health plans could keep a rolling average and turn things over to MHQP every month. If they wanted to.