About those clinic rankings

I know many of the local health care providers well enough to have a good idea of how they must have felt at seeing their favorable performance in a statewide ranking of medical practice quality, published this week by Consumer Reports. It must have been a really good moment for them.

My own reaction? A rush of smugness (or pride, perhaps) for being a patient at a medical practice that did so well.

But on second thought, this may not have been the best response, because it’s not really the purpose of rankings like these to enable people or organizations to feel superior – or, in the case of lower-performing clinics, to be singled out as sub-par. The purpose is to provide one of the many pieces of information that go into health care decisions – which clinic patients should choose and which doctor to see, what type of care an organization should provide and which internal systems should be created for delivering good care.

In an introduction to the special report, Dr. John Santa, director of the Consumer Reports Health Center Ratings, explains why it’s important to collect and share the data:

First, it generates conversations among doctors about changes they can make in their practices to lift the quality of care they provide to patients. And making this information available to patients leads to one of the most powerful forces driving improvement – educated health-care consumers.

The report points out that many factors can influence the performance of a given medical practice. Some of it depends on the patient population that’s served – whether the clinic sees a large number of people who are uninsured, for instance, or has a concentration of frail elderly individuals for whom aggressive disease management might not be appropriate.

A well-known name or suburban location doesn’t necessarily equate to the best care. Many of the top-performing clinics did not have a high public profile, and many were in rural Minnesota.

So how can consumers use the rankings in a meaningful way? What they should not do is flee from a medical practice that didn’t do so well in the rankings – at least, not without careful thought. The advice from Consumer Reports:

Instead, use our Ratings as an opportunity to talk with your doctor about how you can work together more effectively to manage your health. Ask what the practice is doing to improve its performance, and whether its scores are moving in the right direction. And remember that your participation is key, too. Your doctor can only make recommendations; you have to follow through on them.

There’s also the larger picture to consider. Minnesota Community Measurement, the main source of the data for the Consumer Reports rankings, tracks many other measures besides diabetes and cardiovascular care. Medical practices that are mediocre at managing diabetes might perform much better at managing asthma or depression or encouraging patients to follow through with recommended cancer screenings. A medical practice that earns an average ranking one year might improve significantly the next.

Finally, there are the intangibles. Are patients able to have a good relationship with the doctor? Is the staff competent and professional? Is the practice welcoming, and does it take patients’ special needs into account? These things are very difficult to measure but they can matter a great deal.

Perhaps the most important thing about the rankings isn’t the singling-out of who’s the best and who’s the worst. It’s the fact that there’s a useful rating system at all. Not that long ago, information like this simply wasn’t available – or, if clinics were tracking some of these measures internally, it wasn’t shared with the public. Now it’s out there for everyone to see, to talk about and to use the data as a spur for continued improvement.

What’s really remarkable – and something I’m not sure is recognized enough – is what it takes to achieve quality care. Because so much of the effort happens behind the scenes, patients generally don’t see it. Over the years, though, I’ve had glimpses of what’s involved and have come to realize the tremendous amount of work that’s required to earn a good rating. Sustaining this effort week after week, year after year, is even harder.

So, yup, we ought to feel good (and maybe indulge in a few moments of pride) when our clinic does well. Good performances don’t happen by accident.

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