Helping Consumers Make Better Health Care Choices
19 Dec 2012
Publishing information about how patients experience the care they receive at their doctor’s office is one way to increase physician accountability and drive public awareness about health care quality. That was what Massachusetts Health Quality Partners (MHQP) had in mind when it participated in a pilot project with the Robert Wood Johnson Foundation and Consumers Union, publisher of Consumer Reports. The result? In June 2012, Consumer Reports published its first patient experience ratings for nearly 500 primary care physician practices in Massachusetts, expanding the reach of this information as a way to encourage dialogue among patients, physicians, and advocates about what quality healthcare should look like.
The ratings, made available on newsstands and to all Massachusetts Consumer Reports subscribers, were based on MHQP’s statewide patient experience survey results. The survey included questions about the aspects of care that matter most to patients—for example, whether their doctors listen to their needs and concerns, whether patients understand how to take care of their problems after leaving the doctor’s office, whether it is easy or hard to get appointments or have questions answered over the phone, how hard or easy it is to get lab or other test results, and how well their doctor coordinates their care with specialists. These ratings also are published on MHQP’s website and can be found at mhqp.org.
Why is reporting on patient experience important for both patients and physicians? Executive Director of Massachusetts Health Quality Partners Barbra Rabson explained, “Research shows patients who have a better experience of care with their providers are more likely to follow their treatment plans and have better outcomes. The results of our survey can help improve and strengthen the patient-physician relationship. That relationship is the cornerstone of a changing health care system.”
A New Partnership
To help patients and physicians connect in new ways, MHQP and Consumer Reports teamed up to combine MHQP’s skills in survey data collection and analysis with Consumer Reports’ reputation as a trusted source of information for consumers and its ability to present information about performance to a general audience.
Launched in 1995, MHQP formed as a coalition of physicians, hospitals, health plans, professional societies, patient advocates, and government agencies, working together to drive improvement in health care by publicly reporting valid and comparable performance data. To advance this goal, in 2005 MHQP began reporting patient experience survey results on physician performance to provider organizations and the public. When the opportunity to partner with Consumer Reports presented itself, MHQP knew it could greatly increase the dissemination of its patient experience results to health care consumers in an unprecedented way.
“Consumer Reports has been a trusted name for over 75 years,” said Rabson. “Working together helped us to amplify the voices of patients even more than we already had and helped us get this information to patients that we hadn’t reached before.”
Overall, 47,500 adults and 16,500 parents of children responded to the survey. Compared to other similar surveys, this response rate was very good.
The survey asked patients and parents about their experiences with the entire clinic staff, from physicians and nurses to front office staff such as receptionists. Questions ranged from, “Did you and your doctor talk about a healthy diet?” (77 percent responded “yes”) to, “When your doctor ordered a blood test, x-ray, or other test for you, how often did someone from his or her office follow up to give you those test results?” (28 percent did not always receive their test results). Parents also were asked questions, such as whether their child’s pediatrician “seemed up to date or informed about the care the child received from specialists” (66 percent of respondents said “yes”).
Primary care physicians who performed well on the survey “usually take action to operate their practice in a way that focuses on the needs of their patients,” Rabson said. This includes providing test results within a specific time frame, implementing steps for better care coordination, such as using electronic medical records to identify who is due for check-ups, and taking time to address patient’s questions at the time of the visit.
Media coverage about the collaboration between MHQP and Consumer Reports was very positive. The MHQP/Consumer Reports partnership was covered in more than 119 news articles, with more than 27 original stories that appeared online or in print, as well as in 58 radio and two television segments.
Media coverage also led to a spike in website visits, with a total of almost 4 million web impressions since the ratings were released in June. MHQP also experienced a significant bump in social media traffic, including more than 2,100 new visitors to the website and a 200 percent increase in traffic on Twitter during the days surrounding the public release.
The Physician Perspective
Media coverage shows that consumers were interested in the published ratings, but what did physicians think about this project? Michael Cantor, MD, JD, chief medical officer of the New England Quality Care Alliance and a member of the MHQP Physician Council, says obtaining physician buy-in on this project involved overcoming some hurdles.
“Some physicians, myself included, thought this was a really good idea because we live in a world where you can go online and find what looks like objective information about doctors,” said Dr. Cantor, who is a trained geriatrician as well as an attorney. “Others didn’t like being lumped with this Consumer Reports approach. They would say things like ‘I’m not a toaster’ or ‘I’m not a dishwasher.’ Their point, understandably, was that the physician-patient relationship is filled with nuance, and it’s hard to boil that down or rate on a scale. Doctors cope with difficult situations all the time and were concerned whether these evaluations would be fair and would take into account that delivering care is complicated.”
Doctors wanted multiple qualifiers around the information, yet consumers need straightforward information that is easy to understand. This conflict presented a tremendous challenge to present the results in a way that was both clear for consumers and fair to physicians.
Ultimately what brought many doctors around to supporting the project, Dr. Cantor explained, was the recognition that physicians have an obligation to their patients, and that includes providing accurate and current information about care. “People need to make choices based on transparency,” said Dr. Cantor. “The MHQP survey and Consumer Reports ratings help inform those choices.”
Aiming for the ‘triple aim’
The MHQP collaboration with Consumer Reports furthers the discussion about the importance of publicly reporting on physician performance. Under current federal health care reform, doctors and hospitals are being asked to focus on the “triple aim” of lowering healthcare costs, enhancing the quality of care, and improving outcomes. “These ratings with Consumer Reports are one piece of the healthcare quality puzzle,” said Dr. Cantor. “We are in a transition to provide high-value care that is more focused on quality. Massachusetts has been practicing accountable care before the term was on the national radar. We are being accountable to each other and accountable to the public.”
Looking Ahead
“Both MHQP and Consumer Reports have learned a tremendous amount from each other about sharing performance information with the public during our collaboration,” said Ms. Rabson. MHQP will continue to work to engage the public around health care quality performance information. “Whether we decide to continue the partnership with Consumer Reports is unknown at the moment, but we will continue to build on the work we have done with them,” she said.
Lessons Learned
- Strong collaborative relationships are critical in bringing stakeholders to the table and keeping them there. MHQP has long been engaged with its stakeholders around public reporting. Because of the strong relationships and trust built over time, MHQP was able to convene the Massachusetts physician community, health care consumers, and Consumer Reports to develop reporting that would achieve everyone’s goals. Physician and consumer stakeholders met with Consumer Reports on numerous occasions to devise a framing that would be acceptable and balanced to physicians while making the information clear to consumers. MHQP advises other communities that building and strengthening collaborative relationships is necessary before embarking on a highstakes reporting project like the Consumer Reports project.
- To launch this project successfully, MHQP found it was necessary to learn how to achieve balance among the independent perspective of a partner like Consumer Reports, the collaborative process at the core of AF4Q communities, and a regional health care collaborative like MHQP. Both Consumer Reports and MHQP had to take the time to learn about the other organization’s perspective and come to a compromise that integrated processes in a balanced way.