Healthcare quality data doesn't help patients

Today, my 70-something mother called me to tell me about an interesting new site.  The site, which was featured by her local news channel, apparently offers some kind of scoreboard rating surgeons on how often they experience complications.

Being a healthcare weenie, I immediately shot the idea down. “Mom, that sounds like a good idea on the surface,” I said, “but there could be big problems with that data.”

For example, I explained, what if a surgeon had complications or deaths in five out of the ten times she operated? Sounds like she’s a dangerous hack, doesn’t it? Well, maybe not. “What if that surgeon only saw the sickest patients, and the five that did well would be dead or dying without her skills?” I asked her. “Wouldn’t you rather see her than someone who can only handle easy cases?”

She thought about it, and agreed I had a point. So I continued. “If I had to search for a surgeon, I’d love data on how many times that surgeon had performed the surgery I needed during the past year,” I told her, “especially if I needed a complex procedure like a heart or lung transplant.”  By that point, I think she’d already absorbed as much as she could, and it’s little wonder. This is complex stuff.

Unfortunately, my mother isn’t the only one who’s being inundated with allegedly helpful provider ratings info. With countless patients going around with huge deductibles — the conservative economists’ dream! — healthcare prices should be falling and care problem improving dramatically. The thing is, they’re actually having little or no impact on pricing (something my friend Andy Oram outlines brilliantly in a recent article), and even less, arguably, on the quality of care. Even my mother, who has plenty of intelligence and common sense, has no real way to know whether a particular measure makes sense. (Not everyone’s secret ambition is to write for Health Affairs.)

With countless patients going around with huge deductibles, healthcare prices should be falling and care problem improving dramatically. The thing is, they’re actually having little or no impact

As healthcare industry readers know, disputing the value of consumer-facing quality data is hardly a new argument. The battle continues to rage on whether any form of clinician or hospital ratings really captures usable data, or accurately reflect the acuity of the patient mix seen by providers.

The thing is, the issue is becoming more urgent, as employers force staff onto high-deductible plans and many exchange policies sport them as well. Also, the mainstream media is beginning to pick up on the (inaccurate) notion that all consumers need is the right data to make smart healthcare choices for themselves and their families.

Here’s where I stand. While I’m not a clinician or academic healthcare researcher, I’ve been studying and writing about the healthcare industry for 25 years, as well as managing chronic conditions for both myself and family. In other words, I’m about as qualified as any average Jane to leverage healthcare ratings. But even knowing what I know, I highly doubt that I’m equipped to choose a provider based on quality data. In fact, I’d argue that nobody is. Do even physicians know how best to judge their peers? I’d submit that they’d be guessing like everyone else.

The bottom line? Bad provider performance data is worse than none at all. Until some magic day when we figure out how to accurately, clearly and safely profile clinicians and facilities, asking them to rely on performance data can actually put them at risk. Do we want to do that?