The following tidbit was buried within the Kaiser Daily Health Policy Report a few days ago: “Fewer Patients Using Health Care Provider Quality Ratings Web Sites To Make Decisions.” The headline could just have easily read: “More Bad News for Consumer-Driven Medicine.”
One of the most persistent dogmas of the consumerist crowd is that patients are eager to comparison shop for health care—and that, if they aren’t doing so today, it’s only because they don’t have the necessary information. Supposedly, if we had more resources like the website Carol.com—which allows providers to list their services in a comparative “marketplace of care”—then consumers would empower themselves with information and make rational choices on the cost and quality of care.
But according to an October survey from Kaiser, people just don’t comparison shop for health care. In fact, only one in seven (14 percent) of Americans “say they have seen and used information comparing the quality among different health insurance plans, doctors, or hospitals in the past year.” At the same time, 30 percent of Americans say that they came across comparative quality information over the course of this year—which means less than half of patients who come across comparative data on health care providers actually use it.
These numbers stand in stark contrast to the consumerist creed, which insists that, as time marches on, more health care ranking resources will improve patients’ exposure to, and appreciation for, comparative data. Perhaps even more damning is the fact that the proportion of people who actually use such resources has dropped over the past few years: in 2006, 20 percent of Americans had seen and used comparative information, versus 14 percent in 2008. Breaking down this number even further, you find that “fewer than one in ten Americans say they have seen and used information comparing the quality of health insurance plans (9 percent), hospitals (7 percent), or doctors (6 percent) in the past year to make health care related decisions.”
Clearly, comparative rankings in health care are not catching on. Kaiser’s lackluster results were seconded in a survey from the California Healthcare Foundation, which found that “virtually no patients” look at health care rating sites in order to make medical decisions (the actual data point was a measly one percent). "The basic problem of these kinds of ranking systems is that patients do not [really] choose [doctors] on the basis of scores,” said Dr. Bryan Liang of the California Western School of Law to the Press-Enterprise, a Southern California paper. “They choose on the basis of personal familiarity and experience with the health care entity or provider."
Liang is right. Consider a 2005 Wall Street Journal/Harris Interactive poll, which found that eighty-five percent of Americans think that it’s “extremely important” for their doctor to act respectfully toward them; 84 percent said the same for listening carefully and being “easy to talk to.” In other words, patients’ first priorities in health care providers are extremely subjective. Indeed, more objective metrics of physician quality were less important: “Good medical judgment” and “being up-to-date with medical research” trailed interpersonal skills.
How can a third party organization rate how respectful or personable a doctor will be toward you? Sure, there’s some level of abstraction that could be ranked, and even supplemented with testimonials from patients. But ultimately the relationship that you’ll have with your doctor isn’t truly knowable by a third party—let alone a health care ranking company that’s never met you and has no concept of your health care needs, your fears, or your disposition.
Ultimately, patients’ health care priorities aren’t entirely rational—and so relationships, and not rankings, are important. Interaction is paramount. “The best health-care outcomes happen when patients and doctors communicate directly,” Dr. Jeffrey Luther, president of the California Academy of Family Physicians, told the Press-Enterprise.
Clearly, patients can’t communicate with every doctor directly, so there is some degree of third party referral necessary. But think about it: if the standards that most of us use (for better or worse) to assess doctors are subjective, to what sorts of advisers will we turn? The ones who know us best as people: family and friends who know our concerns, our conditions, our worries, our personalities, and so on. Then we work from there and actually meet the doctor, because that’s the only way to truly discover if the chemistry you want is present. In a weird way, it’s actually more efficient to use social networks to help find a doctor than it is a third party ranking system, because the former reflects you as a person to a greater degree than any organization can. Moreover, when many of us look for doctors, we’re sick—and thus probably worried or scared. When emotions run high, we want comfort, and comfort means familiarity, not abstract rankings.
Of course, this doesn’t mean that patients are inherently hostile toward medical rankings. Kaiser reports that, while 44 percent of respondents would prefer a surgeon who treated friends and family over one who had high quality ratings, 47 percent said rating is more important. Clearly, we care about skill. But it would be wrong to say that rank-able metrics are a constant priority for patients: 59 percent of respondents to the Kaiser survey said that they’d prefer a hospital that is familiar to them to one that’s rated highly, while [oonly 35 percent said ratings were more important. Consider these numbers alongside the surgeon stats, and it seems that people want to go to a hospital they know and, once there, get a surgeon they either know or who is renowned for his skill. Well, duh. This seems pretty obvious, whether we live in a world with or without comparative ranking resources. Despite consumerist claims that ratings would dramatically alter the health care playing field, people still think the same way that they always have when it comes to medicine.
A final point: health care rankings can distort because it’s not clear how they assess data. Not all medicine is comparable. As the Press-Enterprise notes, “some doctors might perform more procedures than others…[or] some might treat sicker patients, who require more extensive and costlier care.” Under these varied circumstances, what does it mean to be “better”? A doctor could extend a terminally ill patient’s life and make sure that he dies peacefully, without suffering, while another performs many successful, low-risk procedures on healthy patients. Who deserves the better ranking?.
In the end, our health care priorities are highly subjective, influenced by emotion, familiarity, and perception—and on some level, patients seem to realize this, so they aren’t comparison shopping for their health care.
Neuroscience tells us we’re wired to respond emotionally — human beings always respond emotionally first, then the brain catches up 6 seconds later. It could be that consumers don’t use the “comparative data” sites simply because they don’t capture what’s really important to us in making our healthcare decisions. What’s important is how we feel during the experience.
There is a way for healthcare practitioners and organizations to deliver the experience patients want that is emotionally supportive. Practice management can be aligned to support the emotions associated with healing. There is a ton of research about this. The key is to translate that research to make it actionable.
One company has done this with The Toolkit To Empower Healing and the associated workshop, Creating Healing Experiences That Work. See http://www.experienceinmotion.net. This is based on over 20 year of customer experience consulting work to simplify consulting methodology into “tools,” combined with evidence-based research about what supports healing.
Neuroscience tells us that human beings pick up 20 million bits of data per second from our senses. This input becomes our experience in each moment. The more of those “messages” that are orchestrated to support healing, the more our systems will get that message and respond.
Empowering everyone, and addressing all aspects of the healthcare experience, is important because we pick up on those 20 million bits of data that impact our healing throughout the entire experience. This includes: how the sensory environment feels; the language used in marketing, on forms and by everyone we encounter; business processes; location; movement (or lack of movement); payment processes; home care instructions; and even how the facial tissue feels.
Re-engineering the experience to support healing not only benefits patients on their healing journey, it also benefits the business. One practitioner embraced this approach and increased business by 25% within six months. Practitioners can increase their business by focusing on the experience, especially a healing experience, because when we feel good about an experience we refer. Most hospitals consider ‘satisfaction’ as their measure of doing well. In most situations we usually aren’t happy with mere satisfaction.
In a time when healthcare expenses are going up in all aspects of the system, when people are carefully evaluating how and where they spend money to support their well-being, and when more people are being impacted by long term illnesses, it’s the perfect time for a new approach to empower all aspects of the system. It’s time for consumers to expect and demand healthcare experiences that empower healing, and for practitioners and organizations to deliver healing experiences.
Deb Andelt
Author and Co-creator
The Toolkit To Empower Healing
Would I use a web site rating system for doctors? No. I don’t want someone’s subjective input which is more often based on personalities than on facts. Don’t tell me if the doctor is pleasant, tell me if he is accurate. Only a national database comparing his treatments with others will do the job.
To wit: consumer is a term to denote a person who is planning or actually purchasing goods and services. Patient is a term which denotes someone who is vulnerable and is being cared for by a professional who posses a distinct body of knowledge used to act beneficently and therapeutically on the person’s behalf until they regain health and can advocate and manage independently. There is an underlying assumption that the person is dependent to some degree on others.
That the term, consumer, is being thrown out and up as the same thing as a patient is dangerously, lethally wrong.
And that conflation partially explains the decreasing use of tools to prospectively compare provider quality and costs. As more people lose insurance coverage or suffer from a lack of accessibility to any care, they have no reason to compare what they cannot access and cannot afford.
When they do receive care, it’s likely to be done on an urgent or emergent basis, and they take what ever and whoever they can get.
The free market is not free, and consumers consume where they keep their custom, hence customer. Patient languish, suffer and die as consumers who are penniless and without professional advocates in the guise of nurses and physicians.
So it IS fiction….But a program like eHarmony to make docs and patients compatible, which is, as you say what patients are looking for, might work….
From
http://poemd.blogspot.com/2008/07/opportunity-chapter-anchor.html
“Okay Poppy. We have developed a compatibility program that will help match patients with doctors. You know how they try to match people with a good partner? Matchmakers would consider families, try to find good matches for marriage. There are programs for personal compatibility that use a few questions to line up personality types. We have developed this tool for health care. Some people benefit from a doctor that is tall and powerful, authoritative. Others want a quiet soft-spoken thoughtful kind. So this program will align the needs of the patient with the strengths of the doctor so the two will match. Improve satisfaction in care. Improve outcomes.”
The style of the physicians is also derived from their prescribing patterns and billing data, analyzed…At least in the plot so far..
I have staff-model HMO coverage. If I have some problem that requires a referral I get told that by my Internist, and I wait for them to call me with an appointment time.
Should I need a hospital I go where I’m directed.
If I go look at Internet ratings, assuming they’re available, I can’t change where I’ll go or who will see me and it’s most likely to make me dissatisfied.
My time is better spent figuring out what the best treatment is and querying whoever I see about why that is or isn’t what I’m being offered. I’m willing to accept reasonable explanations.
A physician who researched himself wrote an interesting article in Slate about how useless these evaluation sites are. It’s pretty funny, and, I think, quite correct. Here’s the link:
http://www.slate.com/id/2205201/
All, thanks for the comments–I think we can all agree that the doctor-patient relationship is something you can’t just condense into snappy web profiles!
Oh, and Chris–thanks for the Slate article, it’s a good one!
combine this with the nytimes article on subpar hospitals and you have a good argument that the regulators should be taking the bad apples out of the mix. patients assume, foolishly, a basic level of competence. that’s true in aviation. some carriers are safer than others, but none are truly dangerous.
As with most evolutions, the general public needs educated and incented to research their providers. Typically patients don’t believe they have control over their own care. They would also need to understand the rating system, as to what is considered positive – bedside manner, efficacy of care, cost effectiveness of care, etc. I do think at minimum there should be transparency online as to the volume of a procedure that a provider has completed and their success rate and difficulty rate – meaning that a heart transplant for one type of patient may be more intricate than another. We need to get the public to know where to go, what to look for and why. Right now, the public does not believe they have control over their dollars or their decisions. Different age groups and men vs women will also perceive the need an value for this differently. My parents would do whatever a doctor told them. I would evaluate him and his diagnosis for appropriateness. The data in this article needs to be sliced by age & sex to tell us where we need to focus our educational efforts.
Many of the books I have read agree with what you are saying, that most people do not read quality, cost and outcome information. However, a number of the books and studies I have read indicate that hospitals and providers do improve when there is transparency of their service quality, outcomes and charges.
Chris Camilleri, MD
cp.camilleri@gmail.com
The dearth of consumers doing their homework when it comes to their health is a big letdown. I work in the cosmetic surgery marketspace and like all medical specialties, there are “good” surgeons and not so good surgeons. Patients can only find this out if they shop around. A person has plenty of options when considering plastic surgery in Michigan or other states across the country, and it seems logical that having easy access to this information online is an important innovation that should improve the quality of care overall, but as the Kaiser study found, people have to actually use the information and understand the factors that contribute to quality healthcare.
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Deborah
http://termlifeinsurance2.com