HEALTH - More Tools to Pick Your Doctor

"Beyond Ratings: More Tools Coming to Pick Your Doctor" by Charles Ornstein, ProPublica 4/8/2014

For years, patients have had few ways to compare doctors beyond their reputations. With a huge Medicare data release this week, that may soon change.

This story was co-published with Los Angeles Times.

This week, the federal government is planning to release a massive database capable of providing patients with much more information about their doctors.

The Centers for Medicare and Medicaid Services, the government agency that runs Medicare, plans to post on its website detailed information about how many visits and procedures individual health professionals billed the program for in 2012, and how much they were paid.

This new trove of data, which covers 880,000 health professionals, adds to a growing body of information available to patients who don't want to leave picking a doctor to chance.  But to put that information to good use, consumers need to be aware of what is available, what's missing and how to interpret it.

So, what's out there?

As it stands, patients can go to websites such as Yelp or Healthgrades to read reviews of their doctors submitted by other patients.  They can go to the websites of state medical boards to find out whether a doctor has faced disciplinary action.  If they're really adventurous, they can seek out lawsuit filings.

At its website, ProPublica maintains a database (Dollars for Docs, link below) on which patients can check whether their doctors have received payments or gifts from any of more than a dozen pharmaceutical companies.  Another ProPublica database (Prescriber Checkup, link below) allows patients to look at which medications a doctor has prescribed to patients in Medicare's prescription drug program.  The data enables patients to compare doctors with their peers, seeing if they have unusual practices or conflicts of interest.

This fall, under a little-debated part of the Affordable Care Act, the federal government will release data on personal, promotional and research payments to doctors from all pharmaceutical and medical device companies.  Armed with this information, patients will be able to at least ask whether their doctors have prescribed a drug because it is the best one for their patients — or because of a financial relationship.

It's important to remember, though, that data can sometimes be misleading.  There's a big difference between, say, a hospice doctor giving almost every patient a narcotic and a podiatrist doing the same thing.

As my colleagues and I at ProPublica learned, seeming anomalies are sometimes easily explained.  One Alaska nurse practitioner, for example, appeared to write an excessive number of orders for antipsychotics.  But when we reached her to ask why, she told us that she wrote prescriptions for only a few days at a time to monitor patients' responses.  Her explanation was borne out in the data.

These new tools all have limits.  They won't tell you whether one doctor's patients are sicker than another's and need different therapies.  They won't tell you about a doctor's bedside manner or willingness to return a phone call at 3 a.m.  They won't tell you about a doctor's surgical skill.

It's also far from certain whether patients will embrace the tools.  Currently, an array of information is available about hospitals and nursing homes, but it's unclear that it has made much of a difference in where patients seek care.  Some people would simply prefer to make decisions the old-fashioned way, relying on community networks rather than data.

Still, our experience in making data available suggests lots of people are eager to use this information to drive healthcare choices.  Millions have visited our Prescriber Checkup and Dollars for Docs news applications.

Moreover, despite grumbling from the American Medical Association and others in the medical establishment, the healthcare system has not collapsed because patients are learning more about their providers.

We're still a ways off from having enough information to do an overall comparison of the quality of care from one physician to another.  But Medicare should be applauded for its new release of data, and it should continue to do more.  It should also encourage private insurers and other public programs to follow suit.

Access to information is crucial if patients are to have any hope of answering that most basic of questions:  How does my doctor practice medicine?