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JAMA study: Jury still out on health "report cards"

The report's author says publicly released grades on physicians and hospitals aren't necessarily working to create better health care.

By Andis Robeznieks, amednews staff. March 28, 2005.

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Enthusiasm for public health care reporting should not interfere with the stated goal of such reporting: Improving health care quality.

That was the message of a special communication published in the Journal of the American Medical Association March 9, which noted that the positive impact of public reporting of health care outcome and quality-measure data "is assumed but has not been demonstrated."

In fact, lead author Rachel M. Werner, MD, PhD, cautioned that reporting could have unintended consequences such as physicians choosing patients based on their risk profile, the performance of unnecessary procedures to achieve target rates and the discounting of clinician judgment and patient preference.

"We have to stop assuming that physician report cards are good," said Dr. Werner, a staff physician at the Philadelphia Veterans Affairs Medical Center and an assistant professor in the division of general internal medicine at the University of Pennsylvania in Philadelphia. "We need to improve them to make them live up to their goal of improving quality."

Physician and hospital report cards have emerged in the last decade as health plans, self-insured corporations and consumers have sought information on which doctor or facility is the "best."

Although polls indicate that there is broad support, Dr. Werner said studies show that report cards are not widely understood or used by patients in making care decisions. She also cited studies showing that they are not widely used by referring physicians or by health plans in surgical contract decisions.