We Americans do love report cards, don't we? Where to live, which HDTV to buy, which hot dog tastes best. And experts who think about healthcare policy are hopeful that we'd eagerly snap up report cards on individual doctors, medical groups, hospitals, and nursing homes, shopping for good healthcare the way car buyers inhale Consumer Reports. Providers that didn't measure up would snap to attention or fall out of the picture.
Do you think that would happen? Would you consult healthcare report cards? I would, but I'm probably not a good test case, having subscribed to Consumer Reports for something like 40 years.
Let's say the experts are right. Healthcare report cards have been talked about for 20 years, though, and other than a few good efforts by a few states, I don't see many that are genuinely helpful. This week an arm of the federal government, the Agency for Healthcare Research and Quality, announced a new Web tool--a searchable sampling of more than 200 report cards.
What you get isn't the report cards, but descriptions of the report cards--what they include, how they're organized, where the data comes from. It's meant for the health-assessment crowd, not consumers. But what struck me was that I wasn't looking at descriptions of a movable feast of information. More like cheese and crackers.
Take heart attacks as an example. It's nice to know whether your local hospital treats heart attack victims the right way, and you can find that out on the federal Hospital Compare site. Provided, that is, that the hospital sees a goodly number of heart attacks, because if it doesn't, Hospital Compare won't do an evaluation--the statistics wouldn't be reliable.
A spot-check turned up quite a number of hospitals in the too-few-to-evaluate category. Heart attack isn't the only condition like this--so are pneumonia and hospital infection rates. What good is this? It's like a report card that shows all Incompletes.
Here's a different approach, posted last December on Paul Levy's blog, Running a Hospital. Levy isn't crazy about a plan by the state of Massachusetts to start publishing individual surgeons' death rates for heart surgery. He doesn't have a problem releasing the data. It's that the creaking wheels of the bureaucracy make itthe listing out of date by the time it's posted.
Levy happens to be CEO of Beth Israel Deaconness Medical Center in Boston. His proposal: "The state could set up a website and give password access to each hospital, and we could update the website from our own databases virtually every day of the year. We all keep track of our doctors' clinical volumes. To keep us from 'cheating'--as if we would!--the data submitted by us could be printed in italics and listed as unaudited until the state actually caught up with the figures in its own reports. At that point, the font could switch over to plain type."
Now, that's a report card.