Stop the Phony Quality Measures

By Evan Falchuk

If a web site touted misleading health care information, you’d hope the government would do something about it.  But what do you do when the government is the one feeding the public bad information?

Last week, the Obama administration launched the new Healthcare.gov.

It’s mostly an on-line insurance shopping site.  It is very much a federal government version of sites like eHealthInsurance.com or Massachsetts’ HealthConnector site, which have been around for years.  So when HHS Secretary Kathleen Sebelius, in announcing the new site, claims it gives consumers “unprecedented transparency” into the health care marketplace, you should wonder what she means.

But that’s not the big problem with this site.

Right there in the middle of the top of the page is a big tab that says “Compare Care Quality.”  If you click on it, you are taken to an “interactive web tool” that claims to show you “44 quality measures” about hospitals.  The site says it will help you compare the quality of care hospitals provide.

I decided to look at hospitals in the area where I live, Boston, Massachusetts.  It gives you a list of hospitals in your area, and gives you options to compare hospitals based on medical conditions and surgical procedures.

I decided to compare the Brigham and Women’s Hospital in Boston with the Hallmark Health System in Melrose.  If you don’t know these two facilities, the Brigham is a Harvard teaching hospital, justifiably world-renowned in many areas of care.   The Hallmark Health System is a network of community hospitals, which I suspect most people even in the Boston area aren’t familiar with.

I decided to run my search based on the idea that I was trying to help someone with breast cancer.

The first problem I ran into is this: they don’t have any data on breast cancer.  Actually, they don’t have data for cancer at all.  The only things they can tell you about are chest pain, heart attack, heart failure, chronic lung disease, pneumonia and diabetes in adults.

How about a search on surgical procedures?  Nothing again.  My only option is a “general” search.

Ok, well, I guess it’s a work in progress.  So how do the two hospitals stack up?

They give you a few ways to compare, but the one that I think most pertinent is “outcome of care.”   If you click on that you see that “outcomes” are based purely on how many people died who had a heart attack, heart failure, or pneumonia.  So much for my “general” search (and my cancer patient).

So how do they stack up?  You can’t tell the difference.  Both hospitals are “no better than the national average” in two categories, and “better than the national average” in one.

You get more detailed information – but it only makes things worse.

For example, in death rates for heart attack, the Brigham and the Hallmark hospitals are both “no better than the national average.”  Is that good?  It turns out that that “above average” hospitals are as rare as four leaf clovers – out of 4,569 hospitals in their data set, only 95 are better than average (2%). Only forty-five (1%) are worse than average.  Two-thousand seven hundred and forty four (60%) were “no better than the national average.”

The other 1,685?  They don’t have enough data to figure that out.  The smart money says they’re all “average,” too.

Maybe if I just compare them to other Massachusetts hospitals I will get a clearer picture.  Nope.  Out of 65 hospitals measured in Massachusetts, only nine were better than the national average (14%).  Fifty-one were average (78%), and zero – zero - were worse than average (5 didn’t have enough data).

I know health care in Massachusetts is good -but not a single hospital is below average?

It is deeply misleading to consumers to suggest they inform their health care decisions in any way shape or form by this kind of data.  It’s not that the data is incomplete – it is – it’s that even within the data you can’t tell the difference between a major teaching hospital and a local community hospital.

I’d love to know if the people presenting this as a useful tool for consumers think it really is.  It leaves you knowing less about the differences among hospitals than before you use it.  That’s shameful because the site encourages people facing medical situations to use it for that purpose.  The only thing it is going to do for sure is heighten patients’ anxiety, and make their decision-making more difficult.

  • MKirschMD

    I have devoted (hostile) attention on my own blog about the fallacy of measuring medical quality, specifically toward physicians. the government and insurance companies are gearing up for this, but I don't think that enhancing quality is their objective or is possible. I suspect this is directed more at managing costs. Practicing physicians understand that what really counts in medicine can't be counted.

  • http://twitter.com/murmur55 murmur55

    These BestDoctors lists represent the “lickers list”. I know these doctors at UMass Memorial Medical Center. Some of them are psychopaths or batterers of women employees and patients. See: UMass Memorial Health Care Physicians Named Best Doctors http://bit.ly/9Jg4r0 . It is a disgrace to encourage patients to go for care with some of these abusers. What is your liability?

  • http://twitter.com/efalchuk Evan Falchuk

    Hi,

    The methodology of our database is as follows: we ask doctors to tell us who, in their specialty area, do they consider to be the best at what they do. We collect many thousands of references like this – often hundreds on each doctor. In this way, we get a kind of snapshot of the reputational landscape of medicine.

    It is a fascinating resource in that you can see who other doctors say they trust.

    We use it to find doctors who are especially well-suited to solve the medical problems we present. One of the most serious challenges consumers face when ill is trying to figure out what questions to ask, and to whom they should ask those questions.

    Evan Falchuk

  • Liz

    Hello, our website http://www.yourhospitalguide.com also has local hospital ratings – the website's purpose is to help evaluate various hospitals in the US based on their performance. This could be interesting since the ratings are based on various criteria and are updated timely based on patient reviews and new information coming up. Consider taking our ratings into consideration to see if your judgement about the hospitals you mentioned still holds.

  • Pingback: Podcast interview with Best Doctors President Evan Falchuk. (Transcript: Part 1) | Health Blog

  • Joea

    I found this site by visiting a doctor’s website that I have a problem with. His website is
    http://www.carson-appleton.com . The doctors may be well established and good doctors, but, their social

    skills and the skills of their office personnel are really bad. Here’s what happened to me.
    My daughter was diagnosed as having a possible heart condition. We were referred to Dr Sumbal Sattar of CARSON-APPLETON.com . I called and setup an appointment for the initial office visit.
    2 days prior to the appointment, I was called by the doctor’s personnel and was left a rude sounding voicemail stating my daughters appointment time/date and that I would be charged $35 if I did not show up or did not give a 24 hour cancellation notice. (no biggy)
    The morning of the appointment, I went on-line to get directions to the office. The office phone listed on the site was 725-xxxx. I called the number and was told that the doctors moved and the office was some where else and they had no info.
    So I called the Orlamdo office personnel to get directions. The office girl I talked with was so glad I called and stated we need to change the appointment to another day. I was shocked and said I was ready to go and needed directions or a phone number so I can contact someone. She said there was no phone number available but she needed to change the appointment. I told her about the rude call I received and that they were
    going to charge me if I didn’t give notice and didn’t appreciate the fact that did not work in reverse.
    (no-biggy) She said she was in Orlando and did not know where the office was that I was asking about. So I asked for a phone number to the office to get directions. She told me she did not have a phone # for the office
    was supposed to arrange to take my daughter to. This upset me. So, I went through re-scheduling the appointment. The days I had available, she politely informed me that the doctor would not be available. I told her I needed the week of the 18-27. She claimed the doctor was only available Mon and Wed. She informed me the doctor would not be available that whole week so I rescheduled my apointments to fit in to an earlier date of 13 Oct. I was still concerned about how to get to the office. She then gave me a number to call and said it woulkd not be their people but they could give me directions.
    She asked me to get online and fill out some pre-registration forms which I did and noticed a place for feedback. I left feedback about receiving the rude call and the threat to charge me $35 for no advance
    cancellation notice and politely (and really jokingly) informed them of the incident and told them I would bill them if they decide to cancel and not give me notice. I left info stating I would be at the office appointment on
    Wednesday (13 Oct).
    I never received a call from them. On the day of the appointment, when I got to the office, I was greeted and informed that the doctor would not be there today.
    I was upset to say the least. The greeter said she can call to find out what was going on. She said they decided to discharge my daughter because of the feedback I left them and that the original appointment was not until (Wed) 20 Oct (the date I originally wanted to get but was told doctor would be gone..
    So they basically discharged my daughter and decided they did not need to call me and let me know they were doing this.
    I am filing a complaint with my insurance provider requesting CARSON-APPLTON.com is removed from their provider network/list of referrals.
    Not sure how well the doctors are, since I was never given a chance to meet with them, but obviously their office personnel have some serious issues.

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  • "Medicine is learned by the bedside and not in the class room. Let not your conception of manifestations of disease come from work heard in the lecture room or read from the book: see and then research, compare and control. But see first."
    - Sir William Osler, MD
    The Father of Modern Medicine
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