Time to Rate Surgeons?

[Harrison]

It’s an interesting developing phenomenon that’s been percolating for several years – that is, rating doctors. There has been a smattering of articles about this in the past month in various pubs.

I think the time has come –- are you all ready to “rate” your surgeon? Do you think you can do a better job rating your doctor’s service than Zagat’s (yes, that’s the restaurant guide!). I do. Way better.

We will provide a valuable service by carefully creating a methodology to rate spine surgeons near and far. With the collective knowledge of this community, we can come up with a rating system that is fair, comprehensive and helpful to patients.

Well, wuddayathink? If I had a nickel for every time someone asked about a surgeon in anywhere USA…I’d have a lot of nickels!

See the article below and in the article library.
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N.Y. Attorney General Says Cigna To Alter Doctor-Ranking Program
New York Sets Plan With Cigna Aiming To Set Standard

By VANESSA FUHRMANS
October 30, 2007; Page D3

New York's attorney general announced a first-of-its-kind agreement with Cigna Corp. that may help to establish an industry standard for the doctor-rating systems that health insurers increasingly use to guide consumers.

The deal stems from Attorney General Andrew Cuomo's probe of the way health plans measure -- and publicly disclose -- how doctors rate in terms of quality of care and cost efficiency. Aetna Inc. said it welcomes working with the attorney general on a similar deal, while UnitedHealth Group Inc. and WellPoint Inc.'s Empire Blue Cross Blue Shield said they also are continuing talks.

More insurers and their employer clients are using rating programs to encourage consumers, often through financial incentives, to pick doctors whom insurers rate more highly.

UnitedHealth, for instance, gives doctors and hospitals that follow certain care guidelines and are cost-efficient a "UnitedHealth Premium" designation. Aetna includes top-performing specialists in its "Aexcel" network. Some employers have begun charging workers more if they see doctors who don't earn such labels.
But medical groups and regulators in some states say that many of these programs are confusing and may steer patients to the cheapest, rather than best, doctors. Already the practice has sparked a lawsuit by some Connecticut doctors asking a state Superior Court judge to halt UnitedHealth's and Cigna's rating systems, citing breach of contract and unfair trade practices, among other things.
One of the biggest critics recently has been Mr. Cuomo, whose office has sent letters to Cigna, Aetna, UnitedHealth, Empire Blue Cross Blue Shield and other health plans asking them to justify their methodologies and warning some not to launch the programs in New York without approval.

But at a signing ceremony yesterday, Mr. Cuomo touted the agreement with Cigna as a template for the rest of the industry to follow nationally in ranking doctors, and said his office has asked other insurers to sign on.
Under the terms, Cigna will use established national standards to measure physicians' quality of care; fully disclose how the rankings are designed, and clearly identify the degree to which cost is used to determine a performance score. It will also appoint a "national standard-setting organization" to monitor the ratings program and report to the attorney general every six months on how well Cigna is complying with the agreement.

"Quality doesn't have to be the enemy of cost, but they have to be different measures," Mr. Cuomo said.

The New York agreement could also help keep health-care rating initiatives from getting mired in legal disputes in other states, said Peter Lee, co-chairman of the Consumer Purchaser Disclosure Project, a coalition of employers, unions and consumer groups, and health-policy organizations that endorses public reporting of health-care performance. "We've seen a backlash that's taken the form of lawsuits," he said. "Now, we have a solution that lets us get on with the business of improving health care."

A spokeswoman for Aetna said the company does disclose on its Web site its criteria and methods for measuring doctors but that it, too, is interested in working with a nationally recognized external group "to help make these physician-ranking programs the best they can be for consumers." A UnitedHealth spokesman said the company has sent a 25-page response to Mr. Cuomo's office and already consults with physicians in developing its ratings.
Jeffrey Kang, Cigna's chief medical officer, said the insurer wouldn't complete changes to its ratings systems until its next annual review of physicians, set to happen at the end of 2008 and early 2009.

Courtesy of WSJ. See original at:

http://online.wsj.com/public/article...560674963.html

[tmont]

I only just saw this. Given the discussion regarding patients' surgical outcome titles in the Big File, I think this goes hand in hand.

Yes, I fully agree that patients would benefit from creating a rating system for surgeons (but also for their centers, their teams, the whole pre-and post-op experience) and this shows Harrison's open-mindedness regarding what patients may or may not say regarding 'spine surgeons near and far'.

Kudos, Rich. In the meantime, allowing patients to clearly announce the tone of their experiences in their 'Surgical Outcome' titles seems coherent with what you want to do--and what would be beneficial for all. Why change course?

I think it is a great idea My surgeon was chosen because I spoke with several people on this site who knew him from past experience. When considering ADR or any back surgery it is so important that you have a qualified doctor. Since ADR is new in the US finding an experienced doctor is even harder. Also, I contacted two places abroad and only received one reply which was very discouraging. Any means of rating all aspects of a doctor and practice would be helpful for people beginning this process.

[Harrison]

Trace, one can associate an emoticon on the title of the message (see the icon next to the reply to?), but that does not necessarily adress the issue. And you have some good ideas, feel free to spend the 40-50 hours developing a system! In the meantime, the one we've using for three years works fine, thank you.

Sue, good feedback, thanks.

[tmont]

In the meantime, the one we've using for three years works fine, thank you.

My point exactly. If you hadn't modified people's titles, we'd all be happy and warm and fuzzy. Why don't you go back to leaving people their freedom to name their posts?

[Brad]

I have been on this site for three years now (or so). I have gone through the whole process from beginning to end. 1 year on the site before and two years after surgery. I can say that the title structure works as it should if you really want to have a level playing ground. If you let people write their own titles the person that uses the most dramatic title will get the most attention and this is not good either way. Especially since this is a process and no one title can cover the complete cycle of recovery. I can think of several people who were very unhappy at one point and then became happy later. I can also think of those that were very happy at first and then became very unhappy later. So the titles would be misleading for each unless you get into the text and read the complete story.


Three years now and I can name each and every failure from memory without the help of titles. When they happen I watch closely, I follow them, I worry about them and I pray for them. I also learned from them and this helped me with my recovery. All of the lessons I learned were not from titles, but from the context and the process.

I think Harrison might have even changed my titles once or twice in the last three years.

All I can say to those that have not had the surgery yet is don't rely too much on anyone that has not had the surgery yet (unless they are your doctor ), don't rely on titles to help you make your decision and dont rely on the current flavor of those that are currently posting as this is only a snapshot of what is a very long process. The real meat is in the postings, over time, of those that have had the surgery (good and bad). Take the time to read through all of them. Meet with them if you can, talk to them if possible, email them, do whatever you have to do to get comfortable with your decision. IMHO, if you are worried about titles, you are worried about the wrong things.

I do think that rating doctors (only if you had a surgery) would be a good thing. But how do you control who posts and how often? What would stop a person who is really upset with a doctor from posting 100 times? I'm not sure if you can control this kind of thing on a forum like this. It still comes down to nitty gritty research and reading all the posts (of those that have had the surgery) in detail.

Brad

[CindyLou]

Good points all around Brad. But I thought the "title" topic was closed. Let's not open another Pandora's box.

[LBP]

I think it would be wonderful to rate surgeon experiences.
1. openness during pre surgery and post surgery consultations to discuss all options

2. success of surgery immediately and/or over time

3. Willingness to work with you if problems arise post surgery

4 willingness of surgeons office staff to help with the insurance fight to get ins insurance coverage, and accomodate out of state or out of country patients.

I think this information from personal experiences is INVALUABLE. Also there might be some trends popping up. Maybe some surgeons are getting burned out and/or over booked with other business related commitments as their ADR expertise and demands grow... and patients might be suffering from developing a better dr/patient relationship????? There seems to be a new pattern of discontentment with a couple frequently praised surgeons on this site. Why is this? Are they too busy now? Are they focusing on new technologies and frustrated with unsuccessfull patients of the early ADR models? Or are these just enivitable situations where even the best surgeons have failed surgeries because nothings 100% Are these unhappy people the results of expected statistical events or is there a shift in the quality of care (for various possible reasons) by certain surgeons?

Also I think that even if you haven't had surgery yet...if you've consulted with some of the less mentioned surgeons...you can still share your good and bad experiences. I've had night and day experiences with different clinical trial experienced surgeons and would recommend one over the other! I would want to hear from both those that have had the surgery as well as those that consulted with surgeons in various states/countries even if they couldn't follow through with surgey due to insurance or $ issues, or told they are not an ADR candidate!

[Brad]

Originally posted by CindyLou:
Good points all around Brad. But I thought the "title" topic was closed. Let's not open another Pandora's box.

I was answering Tmonts prior post. You are right though, I won't bring it up again, even if others do

Brad

[KL Aguilar]

I agree with LBP. I had cervical MISS surgery, but I haven't had a fusion or an ADR. However, I have had surgical consults and clinical trial evaluations with two of the top-rated Southern California ADR surgeons. There were many positive and negative differences between my experiences with these two doctors and their staffs. And I have had someone share their story about another surgeon whose office is so poorly run that it was a nightmare dealing with the necessary details.