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Charles Ornstein: More Tools, Beyond Ratings, To Pick Your Doctor

April 9, 2014

Doctor familiarity without the wire taps.

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Image from Flickr via Juhan Sonin

By Charles Ornstein
By arrangement with ProPublica

This week, the federal government is planning to release a massive database capable of providing patients with much more information about their doctors.

The Centers for Medicare and Medicaid Services, the government agency that runs Medicare, plans to post on its website detailed information about how many visits and procedures individual health professionals billed the program for in 2012, and how much they were paid.

This new trove of data, which covers 880,000 health professionals, adds to a growing body of information available to patients who don’t want to leave picking a doctor to chance. But to put that information to good use, consumers need to be aware of what is available, what’s missing and how to interpret it.

Patients will be able to ask whether their doctors have prescribed a drug because it is the best one for their patients—or because of a financial relationship.

So, what’s out there?

As it stands, patients can go to websites such as Yelp or Healthgrades to read reviews of their doctors submitted by other patients. They can go to the websites of state medical boards to find out whether a doctor has faced disciplinary action. If they’re really adventurous, they can seek out lawsuit filings.

At its website, ProPublica maintains a database on which patients can check whether their doctors have received payments or gifts from any of more than a dozen pharmaceutical companies. Another ProPublica database allows patients to look at which medications a doctor has prescribed to patients in Medicare’s prescription drug program. The data enables patients to compare doctors with their peers, seeing if they have unusual practices or conflicts of interest.

This fall, under a little-debated part of the Affordable Care Act, the federal government will release data on personal, promotional and research payments to doctors from all pharmaceutical and medical device companies. Armed with this information, patients will be able to at least ask whether their doctors have prescribed a drug because it is the best one for their patients—or because of a financial relationship.

It’s important to remember, though, that data can sometimes be misleading. There’s a big difference between, say, a hospice doctor giving almost every patient a narcotic and a podiatrist doing the same thing.

As my colleagues and I at ProPublica learned, seeming anomalies are sometimes easily explained. One Alaska nurse practitioner, for example, appeared to write an excessive number of orders for antipsychotics. But when we reached her to ask why, she told us that she wrote prescriptions for only a few days at a time to monitor patients’ responses. Her explanation was borne out in the data.

Some people would simply prefer to make decisions about doctors the old-fashioned way, relying on community networks rather than data.

These new tools all have limits. They won’t tell you whether one doctor’s patients are sicker than another’s and need different therapies. They won’t tell you about a doctor’s bedside manner or willingness to return a phone call at 3 a.m. They won’t tell you about a doctor’s surgical skill.

It’s also far from certain whether patients will embrace the tools. Currently, an array of information is available about hospitals and nursing homes, but it’s unclear that it has made much of a difference in where patients seek care. Some people would simply prefer to make decisions the old-fashioned way, relying on community networks rather than data.

Still, our experience in making data available suggests lots of people are eager to use this information to drive healthcare choices. Millions have visited our Prescriber Checkup and Dollars for Docs news applications.

Moreover, despite grumbling from the American Medical Association and others in the medical establishment, the healthcare system has not collapsed because patients are learning more about their providers.

We’re still a ways off from having enough information to do an overall comparison of the quality of care from one physician to another. But Medicare should be applauded for its new release of data, and it should continue to do more. It should also encourage private insurers and other public programs to follow suit.

Access to information is crucial if patients are to have any hope of answering that most basic of questions: How does my doctor practice medicine?

Charles Ornstein, in collaboration with Tracy Weber, was a lead reporter on a series of articles in the Los Angeles Times titled “The Troubles at King/Drew” hospital that won the Pulitzer Prize for Public Service, the Robert F. Kennedy Journalism Award and the Sigma Delta Chi Award for public service in 2005. His ProPublica series, with Tracy Weber, “When Caregivers Harm: California’s Unwatched Nurses” was a finalist for a 2010 Pulitzer Prize for Public Service.

Ornstein reported for the Times starting in 2001, in the last five years largely in partnership with Weber. Earlier, Ornstein spent five years as a reporter for the Dallas Morning News. He is a past president of the Association of Health Care Journalists and a former Kaiser Family Foundation media fellow.

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