Physicians launch Internet business to grade doctors

Two doctors have founded an online ratings service that they think will be more fair to physicians than similar services already on the Web.

By Tyler Chin, amednews staff. May 8, 2000.

Believing there is a vacuum he can fill as a physician, David Shulkin, MD, left a prominent academic medical center to jump into the controversial business of rating physicians based on the quality of their care.

In October 1999, Dr. Shulkin, a practicing internist, and three partners quit their jobs at two prestigious health care systems to launch DoctorQuality.com (http://www.doctorquality.com/), an Internet firm that rates doctors and hospitals . The ratings service is set to premiere this month.

Three of the partners were key in developing the well-respected disease management program at the University of Pennsylvania Health System in Philadelphia: Dr. Shulkin, former chief medical officer and chief quality officer; David B. Bernard, MD, former senior medical director of the health and disease management program; and Maulik Joshi, PhD, former senior director of quality. The fourth partner, Kevin G. Halpern, was the former CEO of Cooper Health System in Camden, N.J.

These backgrounds and experience in the evolving field of developing best clinical practices and measuring outcomes may give the executives an edge over their online and offline competitors in the ratings arena.

"We're not novices," Dr. Shulkin said. "We have a healthy respect for how difficult the science or work of quality measurement and evaluation is. The science continues to get better, and five years from now it will be even better."

The ratings game

Lawnside, N.J.-based DoctorQuality will use a combination of proprietary methodology, publicly available information and input from consumers to rate physicians and other providers.

Rating physicians, hospitals, medical groups or health plans is an emerging business that has attracted traditional companies, organizations, nonprofits and for-profits, observers say. Besides DoctorQuality, these entities include Healthgrades.com, Lakewood, Colo.; the Pacific Business Group on Health, San Francisco; and the National Committee for Quality Assurance, a Washington, D.C.-based nonprofit organization that accredits managed care organizations.

Medical societies and government agencies also rate physicians. And Internet consumer health sites, including Healtheon/WebMD, also allow consumers to post unfiltered comments about their physicians.

"There is not a great number of companies doing that yet but it's certainly a growing field and level of interest in it," said David Lansky, PhD, president of the Foundation for Accountability, Portland, Ore., a nonprofit group of health care purchasers and consumers dedicated to helping consumers make better health care decisions and informing them about quality of care.

"In very broad terms, I think it is good if [DoctorQuality.com] can provide consumers with information about which doctors and hospitals to see," Dr. Lansky said. "Obviously a great deal depends on the methodology they use and that the information is sound."

Dr. Shulkin knows his company faces a difficult challenge ahead and that time is needed for it to succeed.

Physician discomfort

Physicians shouldn't feel threatened by his company, Dr. Shulkin said, though he acknowledged that some probably will. "There clearly will be a level of anger and resistance. We understand change is not comfortable."

Because of their background, company executives are sensitive to physicians' concerns, Dr. Shulkin said. That's why the company will not use a star system to rate doctors like Morningstar does with mutual funds.

Instead, the company will identify physicians and other providers who pass the minimum threshold through which "we essentially pass judgment on the quality of the doctor or hospital," Dr. Shulkin said. Visitors to the company's Web site will see only the names of physicians and other providers who meet the company's criteria and how they were rated, he said.

A key goal of the company is to identify doctors who practice best clinical practices and see them rewarded for their achievements, he said, explaining that he believes doctors' services are priced as a commodity with no differentiation for quality.

"I do believe there has not been a strong economic reward for those providers that are practicing at a higher level or higher standard of care " when arguably these physicians should be paid more, Dr. Shulkin said.

DoctorQuality wants to change that, and of course, make money while doing it.

Its founders have invested significant personal funds to launch their venture, Dr. Shulkin said. DoctorQuality has received $900,000 from an outside investor and is seeking additional venture capital.

So far, 200 physicians have submitted data to DoctorQuality, which is "cleansing" and verifying the data. It will post its ratings on the Web this month.

These doctors submitted their data after reading about the company in trade publications, Dr. Shulkin said. He added that DoctorQuality does not charge hospitals or physicians for its ratings work, and will make money through sponsorships and sales of products to employers, managed care organizations and hospitals.

DoctorQuality markets three products, including QualitySource, which is a free portal providing health care decision-makers "everything anyone would want to know about improving health care quality," Dr. Shulkin said. Ratings of doctors and hospitals will be available through this portal.

Although QualitySource is free, the company charges a fee for QualityPractices, which are best practices books informing patients what they should expect from their doctors and hospitals if they are treated for specific conditions. The company also charges for QualityOpinions, an external quality review service for patients and their families, initial insurance coverage decisions, denials and appeals and other types of reviews.