The increased availability of Medicare data is increasing the ways for hospitals and patients to evaluate the quality of the doctors working for them.
The health care industry is evolving toward an evidence-based and patient-centric system. As it does, physicians are increasingly becoming the point of change in determining the right care, at the right time, in the right place, and at the right cost.
The notion of physician-specific report cards is one of unparalleled transparency. And from the perspective of RealTime Medicare Data President and CEO Gina McWilliams, it’s long overdue.
“To me, it shifts the discussion to a place that is very, very credible, very, very defensible, and while it’s not yet the end-all-be-all, if we do our job and listen to the market it should change with what we hear,” she said.
While her vision is not available for consumption by the general public, at least not yet, McWilliams’ company has developed exactly that tool for hospital executives. Using a five-point star ranking method, it’s called RealScore MD.
Though it’s still new, early reception of RealScore MD has confirmed that McWilliams and her team are onto an important trend in a post-ACA healthcare system.
Using RealScore MD to analyze Medicare data, hospitals and physicians can monitor referral patterns, eliminate unnecessary tests and procedures and grade general practitioners and specialists.
RealScore MD provides insights into the total picture of Medicare Inpatient practice to help doctors and hospitals change their focus and reposition their practice. By analyzing the data, RTMD can help hospitals understand the variations in the metrics among peers and sell their strengths to patients. It also can help reduce costs by challenging the use of medical intervention when it might not be needed.
This is the first time doctors have had this type of transparency, where they will be graded against their peers and also be able to weigh the competition.
McWilliams didn’t want business people like her to drive the discussion. Instead, she wanted to have physicians see what the product does and let them ask questions. It was important to collaborate with them earlier on to see how best practices could evolve sooner rather than later, she said. So her company brought together a team of physicians and health care management professionals to test and discuss the capabilities of RealScore MD and how it might affect their practice.
One of them was Bill Cockrell, who has been in medical practice management in Birmingham for 33 years. Cockrell said scorecards are beneficial in providing a way to measure physicians’ actions and their quality in ways they never could be before. They can also measure referral patterns in doctors to specialists.
“It is ahead of the curve in giving physicians the ability to understand how they do things today,” he said.
In cardiology, doctors get referrals, but nobody can know what they didn’t get. But using real time data, Cockrell and his team are able to look at referral patterns and actually see doctors who split referrals between several cardiology practices. After looking for physicians who split referrals, he would go back with data and could sit with them and talk about the accuracy of cardiac tests and how it reduced invasive tests. He could then look at data and tell if he had an impact on referral patterns.
“Data is powerful, and taking the right data to people can indeed impact referral patterns,” he said.
Cockrell also took all primary care physicians in a medical center in the state and looked to see where they referred their cardiology patients. He realized they were referred across 17 practices, ranked them by volume, and used data to look at why. Criteria included burden of illness (how sick they were), how long they were in the hospital, and how much it actually cost to take care of patients by doctor. Another factor pulled in was patient satisfaction data.
After that, all the referred doctors would be re-ranked. High volume physicians had sicker patients and had higher volume, and overall results were better. But some of those physicians fell out.
Cockrell said RealScore MD would benefit the doctors and patients by increasing competition and therefore increasing quality. The primary care doctors are going to pick the best specialists, he said.
Specialists are going to be marketing themselves and therefore need to use the accurate data that can be seen — not subjectively, but objectively — to see if they can find the most effective referral tree. And if doctors are not doing well, they need to see what they’re not doing right. On the other hand, if he or she is doing well, it’s important to see why.
“There is an analogy in youth sports: There’s a trend where you play a game and nobody keeps score,” he said. “In the season, everybody gets the same trophy. We do the same in health care but it’s called fee-for-service medicine. It’s based not on outcomes, but on volume. Our system cannot survive if you just keep paying based on volume. We need to get to a place where we have better data.”
Another physician who participated in the focus groups was Dr. Allen Goldstein. Goldstein emphasized the importance of rating the rights things. For example, what makes a patient happy isn’t necessarily what makes a good doctor.
It’s important to look at not only whether a doctor is being honest with a patient, but also how quickly they can respond to a need. For example, fitting someone into a schedule versus sending someone to the emergency room.
“If you’re going to rate a doctor, you rate the doctor on the reality of what they’re doing, not the perception of what they’re doing,” he said.
Looking at the responsibility of costs also is key. Doctors don’t get rewarded for saving money but they are chastised for spending money. Medicare allows you to determine where you can be doing the investigating as to why they are in the emergency room and how frequent.
Then what if you get into the data and find out that patients are going to the hospitals more often after they were switched to a less costly drug, maybe it’s because the insurer doesn’t want to pay for a more costly drug? If so, then the question becomes paying more for a drug or paying more for more frequent doctor visits.
“If you don’t use the data and tie it to what’s being ordered, you can’t win,” Allen said. “You have to order those things that are helpful, not what the patients want.”
McWilliams said she doesn’t know whether the database contains a silver bullet, but the first place to start is by asking the right questions. McWilliams said RealScore MD could become a flagship product for RTMD. But rather than doing a large-scale product launch, the company has been releasing it more slowly.
“Someone can have the best wheat, but it takes someone else to turn it into the best bread.”