Friday, July 24, 2015

Cups half full and half empty

I've been enjoying an exchange over at Twitter with Ben Harder, @benharder, chief of health analysis at US News and World Report.  As he notes, "We publish data, rankings & tools to help consumers choose hospitals, doctors, health plans & more."

In previous posts, I've expressed major reservations about the methodology used by the magazine.  Regular readers might recall my 2011 column where I said:

US News needs to stop relying on unsupported and unsupportable reputation, often influenced by anecdote, personal relationships and self-serving public appearances.

To his credit, Ben has been working on creating a more objective basis for his magazine's rankings, but there is a still a major component that relies on doctors' opinions.  I wish him well in continuing to make this whole exercise more scientific. (By the way, as the magazine notes, their ranking is not for patients with "normal" levels of acuity, but rather is designed to focus on which hospitals best handle the more complex cases. You'd never know that based on how hospitals use the rankings in their advertisements.)

Meanwhile, it has been revealing to focus on other comments in the Twitterverse and blogosphere that have attacked as unconscionable recent stories from ProPublica in which Medicare data on readmissions were used to describe complications rates for America's surgeons.  Oddly, I cannot recall any of the authors of those diatribes taking on any methodological aspects of the US News rankings.

My guess is that the US News rankings have become such an important part of the marketing campaigns of America's hospitals and doctors that any such problems fall away in the eyes of the profession.

But back to our interchange.  Ben notes, with optimism:

Thru NSQIP & PQRS, @AMCollSurgeons "has begun the long, arduous process of [public] quality assessment" of surgeons.

Surgeons' work on "assessing and improving surgical outcomes...will take some time. It’s complex."

I responded:

NSQIP has existed for years. No indication that it will be used for public reporting. Ever. [Note: More on that here.]

I also noted:

Also c new AUA data effort: "By urologists. For urologists." Public disclosure not contemplated. U c progress. I c recalcitrance.  [Note:  Check here for a description of the American Urological Association Quality Registry inititaive.]

His reply:

You may be right. But the winds of change are blowing. Growing # of surgeons want  #NSQIP to open up.

I offered:

Winds of change? More like gentle whispers. As we say in politics, count the votes. Inertia's winning.

He answered:

You see cup empty. I see rain clouds.

I added:
In short, the medical priesthood prevails: "You are not worthy to judge us."

He answered:

Priests will be priests. The congregation is losing its religion.

To which all I can now do is respond by saying, "We shall see."  I see nothing on the horizon that suggests that the public's need to know is as yet offsetting the profession's desire to hold things close to the vest.  When the numbers suit them, the profession extolls the results.  When the numbers don't suit them, it's back to: "The data are wrong.  My patients are sicker."


nonlocal MD said...

"Oddly, I cannot recall any of the authors of those diatribes {against Pro Publica} taking on any methodological aspects of the US News rankings.' One can hardly hear the harpoon going in. Bravo!

What is most disappointing is seeing one of the giants in the patient safety/quality movement joining in on the side of the physicians. Is it not yet apparent that first iterations in this movement can always be improved upon? This is brand new stuff, after all - physicians didn't bother to do it for all those decades when they held the power. No sympathy from this quarter.

Anonymous said...

Not only did you hit the nail on the head, a good number of "patient quality" movements are headed by admin or MD's. You don't see actually any progress other than a bunch of meetings and crap. No results, any that make a difference to harmed patients like myself.