Next month, the Health Care Incentives Improvement Institute (HCI3) will publish methodology that will allow consumers, health plans, provider organizations and others to better calculate complication rates for individual physicians.
This has the potential to empower consumers, payers, and providers to do their own evaluations of physicians based on doctors’ rates of potentially avoidable complications (PACs). A PAC is any event that affects the patient negatively and is potentially under the physician’s or hospital’s control.
AHCJ members are invited to a webcast at 1 p.m. EST on Nov. 12 with François de Brantes, HCI3’s executive director, who will explain the methodology and preview the results of the organization’s third annual State Report Card on Transparency of Physician Quality Information.
This is a scorecard on how well states are doing in making information available to consumers on the quality of care physicians deliver. In the 2014 report card (PDF), only two states, Washington and Wisconsin, earned HCI3’s highest grade. HCI3 reported similar results in its first report.
This year two organizations raised the bar on physician quality transparency reporting. In July, ProPublica released its Surgeon Scorecard and Consumers’ Checkbook released its Surgeon Ratings. Thanks to their efforts, consumers can now shop for physicians based on their quality of surgical care. Evaluating the care of other physicians remains challenging.
“While these two reports are important, we still have broad swaths of care in darkness with very little, if any, information on physician quality, and we’re working on several fronts to solve that problem,” de Brantes said. During the webcast, he will explain HCI3’s new method of evaluating the quality of care physicians deliver, based on each doctor’s PAC rate.
“This methodology will allow consumers, public and private health plans, and provider organizations to calculate and publish PAC rates for individual physicians. HCI3 also will publish these rates,” he explained. To shed more light on the report and the quality of care physicians deliver, HCI3 will release a report that explains the methodology it uses to measure PAC rates for primary care and specialist physicians who treat patients with chronic conditions.
“These conditions affect tens of millions of Americans every year, and our method can reliably measure whether a physician has a higher or lower than average rate of complications when managing chronic care patients,” de Brantes said. “We have thoroughly tested the method with many provider organizations and health plans using commercial data on physician quality.”
The HCI3 data does not name individual physicians, at least not yet. “At this time, we cannot publish the names of physicians along with their PAC rates because we do not have the rights to do so,” he said. “In the coming months we will work to get unfettered access to state all-payer claims databases (APCDs) to calculate physicians’ rates of avoidable complications, and will then publish those numbers along with physician’s names and rates of complications.”
APCDs are large databases that allow payers, provider groups and others to analyze the cost and quality of health care. The databases include medical and pharmacy claims data and eligibility, and provider files from private and public payers and all settings of care. The APCD Council said 12 states have APCDs, 6 states are implementing them, 19 have a strong interest in doing so and the remaining states either have an APCD for which data submission is voluntary or there is no current interest.