Defining and measuring quality in health care isn’t easy. New yardsticks from the Core Quality Measurement Collaborative are a step in the right direction. These new measures cover seven broad areas of medicine: primary care, cardiology, digestive disorders, HIV and hepatitis C, cancer, orthopedics, and obstetrics and gynecology. They include things like whether a doctor has done a specific test or recommended a specific treatment. But they ignore things that matter to most of us.
The Collaborative brings together the Centers for Medicare and Medicaid Services; physician groups like the American Academy of Family Physicians and the American College of Cardiology; and several health plan representatives. Its new quality measures are aimed at reforming payments to health care providers and moving the health care system toward accountable care organization models, tasks that most consumers care very little about.
My company, Vitals, conducted a survey last year that asked people, “What is most important to you when selecting a primary care doctor?”
Here’s what we learned: Many of the responses point to the importance of the patient experience. People want a competent doctor who is friendly and who listens to them. They want a convenient location, accessible appointments, and a courteous staff.
People are increasingly turning to reviews to learn more about a potential new doctor. A report in the Journal of the American Medical Association showed that 59 percent of US adults found online doctor-rating sites to be somewhat or very important in selecting a doctor. More than one-third went to a doctor — or avoided one — based on the ratings.
Working with a doctor you like or a health center you feel good about makes a difference. A large body of evidence shows that positive patient experiences translate into better clinical outcomes.
The most popular response to our survey, “Accepts your insurance,” reflects the economic reality of today’s health care landscape. Higher deductibles, narrower networks, and coshare agreements are shifting more of the cost of health care to consumers. But the issue of cost isn’t just about dollars, it’s also about value.
In health care, cost doesn’t always equate with quality — two virtually identical operations can have costs that differ by thousands of dollars. This leads many people to overspend for their medical care, especially for routine procedures like lab work and magnetic resonance imaging. Consumers can’t untangle value without both cost and quality information.
Outcomes like how well someone fares after knee surgery, or how well his or her diabetes is controlled should be the key measure of health care quality. The latest efforts by the Collaborative move in that direction. But even when outcomes are king, it’s hard to believe that reviews and opinions will become obsolete. From my experience helping millions of people choose a physician, my bet is that outcomes data will not sideline other inputs, in part because each patient defines quality in different ways — even from one episode of care to the next. For an individual who needs only regular six-month dental cleanings, convenience may be the most important measure. For someone who requires frequent physical therapy, it’s about value and access. For someone with a rare disease, physician experience matters most.
Streamlining quality measures to reduce paperwork and ease billing headaches makes sense for health care providers and the health care system. But if the goal is to transform the way patients choose providers, we must factor in what matters most to them.
Mitch Rothschild is the executive chairman and founder of Vitals, based in Lyndhurst, New Jersey.
