nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Tuesday, August 3, 2010

Rating Systems For Doctors...I'm For It, With Reservations

Patient Groups and Insurers are posting ratings of doctors.  But assessing quality of care is complex.

I agree with the Washington Post health blog (Aug 3) that insurer rating systems need to be viewed from the perspective of the insurer:
The systems provided by some health plans to rate doctors are typically based on two factors: cost and quality. Data that measure the quality of care -- whether a diabetic gets regular blood-sugar tests or foot exams, for example -- are not as easy to translate to the level of individual doctors but cost is, so cost tends to be the bigger factor.  "Often insurers will do a two-step process," says Ha Tu, a senior health researcher at the Center for Studying Health System Change, a nonpartisan research and policy organization based in Washington. First, they "make sure doctors meet a quality threshold, but not a very high one. Then they'll weed them out further based on cost."
Patient groups similarly may focus on the aspects of healthcare they identify as important to them.  The American Diabetes Association, for instance, would adopt a rating system that defines quality very differently than would the Autism Society of America.

A first step, then, for all these raters would be to ascertain their focus.  What are they most concerned about in health care? 

From there go on to what things they rate, and how they rate them.  Clearly a rating system that looks at the chairs in the waiting room is not superior to one that looks at surgical complication rates.

I am a great believer in patient-directed care (not "patient-centered" see my post here).  I'm certain that with total information transparency about value and cost anyone can make the best health care decision for themselves (and by themselves).

Doc D

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