Thursday, November 18, 2010

How To Find a Good PCP?

I was reading a post this morning on Health Beat on CMS's attempts to create a "Physician Compare" website. The idea is that our government will create an easy and accessible site that our patients (ie customers) can go when searching for a physician.

Such information as medical school attended, years of practice, law suite history, and location will be available as well as data representing quality indicators.

I have very mixed feeling about such a site. While on the surface this looks like a good idea....I would challenge my readers to come up with a series of data points that would define what makes a good primary care physician. say...easy. They have to be nice. Communicate well. Have a clean office with good personnel. And oh yah...they have to be good at doing that doctor thing. You know that thing where they diagnose and treat patients correctly. Where they balance the existing medical data, each patients unique situation and needs, and yes even cost effectiveness to come up with a tailored plan.

That so called "doctor thing", which I would argue is the most important quality indicator, is just not so easy to measure. Especially in primary care.

Yes we can tabulate how often Dr. X's perscribes colonoscopies. And how Dr. X's patients Hgb A1c's usually range. We can see how close Dr. X gets to the correct blood pressure goals (even though depending on the data each year these goals are revised!).

But none of that really says a stinkin thing about quality. Sicker, poorer, less educated patients tend to be less compliant. I can offer every patient that walks in my door a colonoscopy but that doesn't mean it will get done.

And then there is the problem of gaming the system. Create quality indicators and physicians will be great at bumping the numbers but what will be ignored at the sake of quality. I know you are having chest pain Mr. Jones...but when was your last colonoscopy? Why is your a1c so high? As seen in England, incentivize physicians to ask certain question and do certain tests. They will be compliant. But it will divert their attention from other important issues.

Lastly, how is the government going to attain such data. Up to this point, medicare is incentivizing physicians to report quality indicators with programs such as PQRI which give bonuses for voluntary reporting. The carrot, however, will become a stick in years to come when physicians will be penalized for not reporting.

So...take beleaguered, unhappy, primary care physicians who are already in shortage and overworked, add more reporting requirements which will take up more of their time and add to their overhead. And see what the future will bring (hint....many less PCPs..which I guess is OK if you don't value their worth!).

The problem is that the number one indicator of physician quality (in my humble opinion) is diagnostic acumen. And that...that my friends is exceedingly hard to measure.

So how do you find a good PCP?

I have no flippin clue!

But if any of you figure it out could you please let me know.....It's hard to find an excellent pediatricians these days!


Plaque Imaging said...

having a site will help both patients and doctors but you're right that it would be hard to decide which doctor to choose based on their credentials alone. the true measures of a good primary care physician simply can't be put into data, unless testimonials from patients will be included in the site.

WarmSocks said...

There are already many sites that list basics regarding where doctors were educated, their board certification, and other details. I see no need to spend tax money duplicating what is already available for free.

There are doctors in my area who currently require patients to "apply" for an opening in the practice; they won't accept patients with chronic conditions. When doctors are judged on "quality" indicators, this will become even more common, and "good" scores will come to mean that the doctor doesn't treat people who need the most help. Patients will be able to look for "bad" scores to determine whether or not the doctor will even consider helping them.