National Committee for Quality Assurance report on The State of Health Care

The National Committee for Quality Assurance (NCQA)  has published a report on The State of Health Care.

The NCQA is devoted to measuring quality in order to improve health care.  The 162 page report is chock full of information.  Some of the highlights include:

• The report found no significant link between amount of health plan spending and the quality of care delivered (at least the measurable quality of care). The health plans that spend the most don’t always deliver the best quality.
• Vaccination rates have dropped for kids in private plans, while rates continue to rise for Medicaid children.

The decrease in childhood immunization rates is scary.  I guess people are forgetting how horrible these preventable childhood illnesses can be.  To read more about some of the key findings, click  here.

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Round-up of ‘Getting Better Healthcare’ programs

Make sure you check out the Getting Better Health Care Radio Program on webtalkradio.net. My latest interview is with Dr. Nancy Oriol, founder of the award winning Family Van program in Boston. She tells us about the barriers to accessing our health care system and how reaching out to the community can help reduce those barriers.

Want to reduce your health care costs? Don’t miss my interview with Dr. Cynthia Koelker, author of 101 Ways to Save Money on Healthcare.   She tells us how we can save money on preventive care, including information on which screening tests we need and which we don’t.

The previous show with David Coates talks about the politics of making needed changes in our health care system.

Another show not to be missed is the interview with Dr. Sandra Kweder, Deputy Director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research.  She explains what the FDA does to assure that marketed drug products are effective and safe.

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Does board certification matter?

An August 2010 article in Physicians Practice magazine questions whether board certification of doctors is overrated. The article points out that board certification provides a guarantee of a certain level of knowledge and that recent board certified doctors are required to maintain that certification with periodic examination over time. The article also pointed out that studies have not found definitive evidence that seeing a board certified physician results in better outcomes than seeing a doctor who isn’t board certified.

No study will probably ever show a big difference between board certified and non-board certified physicians, perhaps in part because the great majority of U.S. physicians are board certified. We can almost take for granted that U.S. physicians practice within the scope of their training because of the existing certification system.

The American Board of Medical Specialties (ABMS) is a supervising board that oversees the board certification of 24 medical specialty boards. You can find out if a doctor is board certified at their Web site www.abms.org. You can learn more about board certification by listening to the conversation I had with Dr. Kevin Weiss, President of the ABMS , on Web Talk Radio.

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Making patients wait

On June 29, 2010, the New York Times published an article by Jennifer Schultz entitled Punishing Doctors Who Make You Wait, an article which begins by claiming: “There’s nothing worse than showing up on time for a doctor’s appointment and then having to wait because the physician is running late.”  According to our research at DrScore, that simply isn’t true.

Data from the patient satisfaction surveys collected at DrScore.com tell a different story.  While it is true that keeping patients waiting lowers patient satisfaction, it is only by a very modest degree.  Much more important in determining satisfaction  is whether the patient saw a friendly, caring doctor. When it comes to patient satisfaction, there’s nothing worse than seeing a doctor who you don’t think is friendly and caring.

Of course it is a bad idea to keep patients waiting.  But if patients are kept waiting because a doctor cares so much that he is giving each and every patient all the attention those patients need and deserve, patients are generally very understanding.

Schultz’s article goes on to suggest asking the doctor for a discount if the patient has had a long wait.  I’m not so sure that’s a good idea.  I’m willing to wait for my doctor if she’s busy with another patient who unexpectedly needed more time, because I know my doctor would spend more time with me if I were the one who needed more time.  That’s all the compensation I need.

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Agency for Healthcare Research and Quality

The Federal government’s Agency for Healthcare Research and Quality (AHRQ) is helps support the development of medical treatment guidelines and efforts to improve health care efficiency. Some people worry those are euphemisms for rationing health care.  I discuss with Dr. Carolyn Clancy, Director of AHRQ, what the Agency is really doing on Web Talk Radio.

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Enhancing patient satisfaction on a system-wide basis

Doctors are doing a great job. The distribution of scores is skewed toward scores of 9 and higher. Having an average score of anything less than 9.0 out of 10 is, relative to other doctors, a pretty low score.

Medical systems — hospitals, medical schools, etc. — can focus on their doctors’ absolute scores (how happy patients are) or on relative scores (how high doctors’ scores are compared to their peers). The latter can be problematic.

Doctors who get a 9 out of 10 from all their patients are giving great medical care.  But compared to most doctors, that 9 out of 10 is actually a low score! A doctor with a score in the high 8s might be only at the 25^th percentile (ie, a score lower than 75 percent of other doctors). But the great majority of the doctors’ patients may still be extremely pleased with the doctor and the care that doctor provides.

It is interesting to consider how administrators of a large medical center should react to having doctors that average among the 25^th percentile of doctors. Should those administrators be concerned that their doctors are doing a poor job relative to other doctors or should they be optimistic that patients love these doctors, that the average score is still 9.0 out of 10? I think focusing on the 25^th percentile and saying the doctor is doing poorly is wrong and will leave hardworking doctors feeling demoralized. Letting the doctor know that the average patient gives them a score of 9 out of 10 is likely to be more encouraging, but still allows recognition that there is room for improvement.

Administrators probably realize that having even a small fraction of unhappy patients isn’t good for a health system. Unhappy patients are a risk: they may communicate their bad feelings to other potential patients, but more importantly, they are unhappy. Our raison d’etre is to get patients well and happy!

Settling for a 9.0 out of 10 (knowing that it means that 1 in every 10 or so people may have been very dissatisfied) isn’t good enough for any doctor, especially when we know it means there are patients who were very unhappy with their care. We strive to make every patient completely satisfied with his or her medical experience. Hopefully patient feedback services like DrScore.com will help doctors achieve that goal.

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Leaving patients unhappy is bad medicine

In my last blog, I pointed out that doctors’ overall patient satisfaction scores are very dependent on how often patients are completely dissatisfied. Even if there are only a few highly dissatisfied patients, it can lower a doctor’s patient satisfaction score considerably. And that’s the least of the problems with unhappy patients.

Leaving patients feeling uncared for and dissatisfied increases doctors’ risk of being sued for malpractice. These unhappy patients may also share their poor experiences with their friends, hurting the doctor’s (and all doctors’) reputation.

Worse yet, these dissatisfied patients are at risk for having poor outcomes. Poor outcomes leave patients angry and disappointed, and leaving patients angry and disappointed results in patients having poor outcomes. I think this is probably because these patients are less likely to use their medications. Since our goal as physicians is to get patients well, we also need to make sure our patients are satisfied with their care.

But the biggest problem of all with having unhappy patients is: having unhappy patients. We didn’t spend all those years in training because we don’t care about our patients. We care deeply about them. If they aren’t happy, neither are we.

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National Quality Measures Clearinghouse

The U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) has a listing of validated measures of medical quality: the National Quality Measures Clearinghouse (NQMC). The NQMC is a database of information on evidence-based health care quality measures. NQMC is sponsored by AHRQ to promote widespread access to quality measures by the health care community.  On March 8, 2010, the NQMC added the DrScore.com patient satisfaction survey to their list of quality measures, recognizing the scientific validity of our survey. 

We’re proud to be giving physicians an easy, inexpensive and scientifically validated means to assess their patients’ satisfaction and thereby further enhance the quality of medical care physicians provide.

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Service Is Important

Even though the direct consumer purchase transaction is not typical in a physician-patient relationship, that does not mean that service should go by the wayside. Physicians need to listen to patients’ needs and be responsive to patients’ complaints.

As a physician, I know that providing great medical care is a constant challenge. It involves long work hours, being on call, continuing medical education, and too many business and regulatory issues. Many doctors hang by a thin thread, and a patient complaint pulls hard on that thread. Unfortunately, we don’t have a service desk like Best Buy where we can direct all complaints, concerns and returns that don’t work out!  Maybe we should.

There is some wonderful advice for doctors on how to manage patient complaints in an article by a dermatologist, Joseph Eastern, M.D. I’ve adapted here: 

• Put systems into place to prevent patients from having something to complain about. Give patients prompt, attentive, thorough care in a pleasant, friendly environment.
• When patients do complain, don’t take it personally (even if it is). Consider the complaint a gift, something that will help you to give better care in the future.
• Before doing anything else, contact the patient personally and ask him or her to describe what happened. Listen carefully. As you listen, remember, the patient is helping you.
• Ask the patient how the issue could be rectified to their satisfaction. Often, it will be very easy. In fact, more often than not, by showing how much you care about the patient and listening to his or her complaint, you will have already solved much of the problem.

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