Thursday, December 04, 2014

Pulling out all the stops

I'm trying to figure out what's going on here, following up from my recent post about a hospital system president who encouraged his doctors and former trainees to register on Doximity so they could influence the US News and World Report hospital rankings.

Avery Comarow, who is in charge of the rankings, offered a comment to me on Facebook to clarify the situation:

For a full explanation of the relationship and how the coming physician survey will be conducted (and why hospitals that try to recruit their doctors to join Doximity won't benefit), see this site.

Look what it says:

If you are a hospital leader, you may be deliberating whether to encourage affiliated physicians to join Doximity and/or participate in the upcoming survey. It’s your call. If an appeal from you increases the number of physicians who participate in the survey, it will enhance our statistical power to calculate reputation scores for all hospitals. But your decision will neither benefit nor penalize your hospital in the reputation survey or in the rankings as a whole, because of the statistical adjustments we will make.

Unlike our nation's imperfect electoral system, which counts the opinions of only those who show up at the polls, the U.S. News reputation survey statistically represents all survey-eligible physicians, including those who don't receive a survey as well as those who receive one and choose not to respond.

If you are a physician, you may be wondering what effect joining Doximity would have on your participation in the survey. Any decision to join Doximity should be made with full awareness that doing so will neither increase nor decrease your net influence on the U.S. News rankings.

But, for some reason, the message has not been received.  Look at today's note from David Battinelli, Senior VP and Chief Medical Officer of North Shore-LIJ Health System:

Dear Colleague,
As you know, each year U.S. News & World Report publishes their Best Hospital rankings. Last year U.S. News partnered with Doximity, a web-based physician network, to enable Doximity members to vote online for hospitals they believe provide the best care in their area of board certification.  Online votes from Doximity members, along with paper surveys mailed to a small number of non-Doximity members, determine the Reputation component of the rankings, which accounts for 27.5% of the overall score.  

Similar to last year, all board-certified physicians who are members of the Doximity network are guaranteed an invitation to vote in the coming year’s rankings.  Unlike last year, U.S. News will no longer be using the AMA Physician Masterfile as the source for randomly selecting non-Doximity members to receive paper ballots.  Instead, U.S. News will use Doximity’s proprietary masterfile, comprised of both its members and non-members, including those who’ve never heard of Doximity.   

Therefore, we encourage our physicians to take the following action on the Doximity website prior to the imposed cutoff date of tomorrow, December 5:

So given the US News advisory, why this push for signing up on Doximity?

I can only conclude that these rankings have taken on a life of their own in the minds of hospital executives.  This whole thing has become such a marketing tour de force that the executives don't dare take a chance that--even if meaningless to the outcomes--they haven't pulled out all the stops.

What a stupid use of managerial attention.


nonlocal MD said...

This just gets more and more absurd. Any self-respecting member of these medical staffs should throw those letters in the nearest trashcan.
However, it illustrates a disturbing phenomenon - with more and more physician practices 'owned' by hospitals, more and more physicians will be subject to such irrational executive whims and the pressure which can be brought to bear by an employer. This was my greatest fear about the power imbalance of the physician employment model, and this vignette provides ample reason for fear.

Barry Carol said...

To the extent that the U.S. News & World Report hospital rankings gained credibility as an evaluator of hospital quality in the eyes of patients, whether deserved or not, I find it hard to fault the North Shore-LIJ executive for his effort to help his hospital’s ranking in the survey.

Perhaps one of the foundations like Robert Wood Johnson or Bill and Melinda Gates would like to take on the task of developing objective, relevant and credible information that would better assist patients in evaluating both hospitals and doctors. Hopefully, the end product would be a cross between Consumer Reports and Angie’s List.

One piece of information that I would especially like to see is a preference for which hospitals doctors and nurses would go to themselves if they or a family member needed a particular procedure or course of treatment. It might be hard to get an honest answer though if the real preference is for a hospital other than the one the doctor works for.

With respect to individual doctors, I would like to know how many doctors and nurses they have as patients and whether that number is considered high, average, or low compared to peers.

Peter Yang, MD said...

Can someone please inform me: what is the value proposition that doctors are supposed to get from Doximity?

One must wonder what all the conflicts of interest are in terms of this whole situation. It's suspicious why US News would assume that Doximity users represent a fair sample of physicians.