Can you earn an ‘A’? New report cards raise the bar

Patients view ratings of groups, not just plans

Physician practices in California, Oregon, and Washington took a major step toward greater accountability to consumers with the release of detailed patient satisfaction and outcomes information in September.

"Patients generally get their care not from health plans but from providers," says Alan R. Zwerner, MD, JD, president and chief executive officer of The Medical Quality Commission in Seal Beach, CA, explaining the impetus for the project, the Physician Value Check Survey, which drew the voluntary involvement of 58 medical groups or independent practice associations.

The Medical Quality Commission, a nonprofit organization that promotes health care quality and research, sponsored the survey with the Pacific Business Group on Health, a business coalition based in San Francisco.

The survey included questions about access to care, promptness, cost, technical quality, and doctors’ communications skills. Patients reported on their physicians’ management of high blood pressure and/or high cholesterol, such as advice to eat less salt or to lose weight.

Respondents also completed a health status survey and will be surveyed again in two years to determine changes in their satisfaction and functioning.

"In a free marketplace, provider organizations compete with one another for patients," says Zwerner. "Those organizations have to be willing to be scrutinized and measured over time to see whether they’re improving as compared to their competitors."

In fact, the survey showed the readiness of provider groups to engage in those comparisons. "I have not heard a single negative from any of the participating groups," Zwerner said shortly after the results were released. In fact, some medical groups called to say they wanted to be included in future surveys.

"This really will provide a benchmark for an organization to see how it compares with others," says Richard E. Dixon, MD, medical director of the National IPA Coalition in Oakland, CA. "I think it will drive improvements in those aspects that affect satisfaction."

The Physician Value Check Survey sought responses from 62,000 members of managed care and preferred provider plans in 58 medical groups and independent practice associations. Some 34,000 patients responded, for a response rate of 55%.

Perhaps the most ambitious area of the survey involves a long-term plan to measure health status as an outcome of provider care. The current respondents will receive another survey in two years, including the health status questionnaire.

"We hope to get some data that tell us [about patients] at the margins — the people who did markedly better or markedly worse in what one would expect over time," says Zwerner. "We hope to see some positive correlation with appropriate services over time."

While the methodology hasn’t been determined yet, Zwerner anticipates pulling medical charts to review care and connect it to changes in health status.

The project was funded by several pharmaceutical companies, the Henry J. Kaiser Family Foundation, and the Pacific Business Group on Health Quality Improvement Fund. Participating medical groups and IPA’s each contributed $2,000.

[Editor’s note: Survey results are available on the Pacific Business Group’s consumer-oriented Internet site,]