Most doctors in the U.S. continue to see and treat Medicare patients, of course, but the controversy of new scorecards and Yelp ratings tied directly to Medicare data could have a negative influence on their decision to see patients with reimbursement rates that are lower than private insurance.
That was the question put before the large physician social network known as SERMO recently and almost 1,500 physicians responded.
Nonprofit news organization ProPublica released a scorecard for surgeons in July that compares doctors on complication rates for a variety of common procedures of Medicare patients. If there were scorecards for your specialty, would it affect your decision to take (or not take) Medicare patients?
NO – 59% (874/1480)
YES – 41% (606/1480)
SERMO is one of the largest social networks exclusively for physicians. A key feature of the network is being anonymous, which fosters the open exchange of information, insight and second opinions within a large clinical network with no risk of recrimination. [NB: Poll results were verified by SERMO sources but are not publicly available]
The potential for unintended consequences around the use of scorecards and Yelp ratings is not without considerable merit. A 2011 study published in Health Affairs (here) highlights some of the existing friction around payment type.
- 96% of physicians accepted new patients
- 31% of physicians were unwilling to accept any new Medicaid patients
- 17% of physicians would not accept new Medicare patients
- 18% of physicians would not accept new privately insured patients
Things like Yelp ratings and scorecards that are built using Medicare data could have a chilling effect on accepting patients with lower reimbursement rates at all. Providers have no obligation to accept Medicare (or Medicaid) patients ‒ and reimbursement rates (and volumes) weigh heavily on many small clinics and solo providers.
Similar findings relative to quality of care were also evident in a recent survey of 1,624 primary care physicians by The Commonwealth Fund and the Kaiser Family Foundation.
Perhaps unsurprisingly, the survey finds that performance assessments and financial penalties tied to patients’ outcomes are unpopular among providers. Half of physicians (50%) and nearly four of 10 nurse practitioners and physician assistants (38%) feel that the increased use of quality metrics to assess provider performance is having a negative impact on quality of care. The Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers
Reimbursement by payer category was also rated by The Commonwealth Fund/Kaiser Family Foundation national survey.
As a part of the SERMO poll, doctors sometimes weigh in with their own personal comments. Here's a sampling of comments associated with the recent scorecard poll.
Data can be manipulated to serve the interests of those who use the data. Ask any marketer who can sell you anything by how the information is presented! There are so many factors to taking care of patients, including patient compliance itself. Scorecards do not capture these variances rendering them essentially a waste of time. Let natural selection and our BORM's do the job of weeding out "bad performers". Scorecards are simply a mechanism for insurers including Medicare to de-credential high spenders. Internal Medicine Doctor
Several orthopedic procedures are on the list, but only one urologic procedure and one general surgical procedure. I wouldn't evaluate a general surgeon solely on her cholecystectomies, nor would I evaluate a urologist solely on his radical prostatectomies. Pathologist
Look at the study methods (in the full report, not the summary). It is only looking at medicare FFS, does not compare to rest of medicare, commercially insured, or general population. Most active surgeons in my community and others, don't even make the list. A score card evaluating the 8 procedures on Medicare patients on even days of the month with a quarter moon might yield similar results.General Surgery
When New York State and Pennsylvania started reporting bad data (e.g., mortality rates without risk stratification) on cardiac surgeons, more patients were sent out of state. As documented in the NEJM, the Cleveland Clinic suddenly got a lot more bad cases referred to them. This may well happen in general surgery too. Why take on the tougher cases when a few inevitable complications give you a bad batting average that everyone can see? Cardiothoracic Surgery
Statistics behind the SERMO network are helpful in understanding the scale and value of clinical opinions collected through it ‒ even if the process itself isn’t scientific.
- About 305,000 US doctors are SERMO members (~40% of American physician community)
- About 38,000 UK physicians are members (~16% of UK physician community)
