The Editor’s Note: The Ratings Game

“Dr. Joe Smith at XYZ Memorial Hospital nearly killed my wife then lied to cover it up.”

“If you see this doctor, please get a second opinion!”

“I was also told by [a] friend that Dr. Murphy prescribed an adult medicine to an 8-year-old girl, and she nearly died.”

So read some of the posts on Doctorscorecard.com, one of many popular Web sites that allow users to post comments and issue “ratings” of physicians for anyone to see. The Web sites are intended to serve people looking for a physician, but they also function as a forum for nasty, often personal, attacks against physicians named publicly by anonymous accusers. It took me about 10 minutes to find these examples, and there are plenty more. One poster accuses a physician of having “a mental problem,” while still another said her doctor’s own nurse “confided that she often goes home in tears.”

Is any of this stuff true? Who knows? It’s impossible to determine what really happened in these encounters, or even whether there was an encounter. (That’s why I’ve changed the physicians’ names here.)

But most people are smart enough, one hopes, to look askance at ad hominem attacks by nameless Web posters. As unfair as these types of sites are, I think their flaws are so obvious and their credibility so suspect that they are the least worrisome manifestation of the increasing efforts to “grade” physicians online.

Of greater concern are the equally dubious report cards in use (or planned) by large insurers - in many cases giving financial weight to the results.

Last month WellPoint, the nation’s largest insurer, launched a system that allows patients to score physicians in areas such as office environment and trust. Its partner in the effort: Zagat, the well-known restaurant-and-hotel rating outfit for travelers.

Missing is any information about the quality of physicians’ clinical care. WellPoint says it is only trying to offer information on the “patient experience.” Ron Pollack, director of Families USA, says such a method “paints only a portion of the picture,” adding: “I want to know how competent [physicians] are.”

But that is an elusive goal. Judging individual physicians’ clinical abilities can’t be done fairly with patient surveys or Internet ratings.

Nor can it be accomplished using insurance claims data. Yet the popular trend among payers is to use such data to develop tiered networks of “preferred” physicians and offer patients financial incentives to switch to them. The plans say they rate physicians using some combination of clinical quality and “cost effectiveness,” but because they’re just analyzing claims information, they’re learning more about how much a doctor costs the health plan than about her competence.

Andrew Cuomo, the state attorney general of New York, recently threatened legal action against a number of insurers over these schemes. To his credit, Cuomo recognized that the efforts were about reducing health plan cost, not increasing quality. Cuomo got several insurers to “voluntarily” scrap these systems.

The best physician rating system would be administered by an independent third party that would collect and aggregate data from all the payers and Medicare, then report them based on adherence to accepted clinical protocols.

No, I’m not holding my breath, either.

Bob Keaveney is executive editor for Physicians Practice. He can be reached at bkeaveney@physicianspractice.com.

This article originally appeared in the February 2008 issue of Physicians Practice.