Doctors Say No to Patient Reviews on Medicare Website

By Mindy Yochelson

Physician groups are trying to dissuade Medicare from adding patient reviews of their experiences with doctors to the agency’s Physician Compare website.

It’s a Yelp world out there, and the Centers for Medicare & Medicaid Services wants to incorporate beneficiaries’ reviews on the Physician Compare website. The site helps consumers find information on health-care professionals participating in Medicare. Quality measures are being phased in to help consumers make choices.

Beneficiaries are anxious to hear from others about their experiences, the CMS said in a proposed quality program rule issued in June. But doctor groups, including the American Medical Association and the Medical Group Management Association, are opposed. Reviews could unfairly damage a medical practice’s reputation, the MGMA said. It’s premature for the CMS to implement the narratives in a national program, the AMA said. Comments on the rule were due Aug. 21.

Physician Compare users “regularly ask for more information from patients like them in their own words,” the CMS said in the proposed rule.

The agency is asking for input for future rulemaking on adding results from five open-ended questions about beneficiaries’ experiences with medical professionals. This would be done as part of the Medicare physicians’ quality measure reporting program, known as the Merit-Based Incentive Payment System (MIPS).

Doctors could choose to participate in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey measure, which would count toward their MIPS performance measure requirements. The questions to beneficiaries would be part of the CAHPS survey.

Doctor Reaction

The MGMA said it’s concerned because, as part of the MIPS quality measure program, the narratives would be used to adjust physician payment, as well as for public posting.

It’s frustrating for practices to deal with the administrative hassles of correcting misinformation on Physician Compare and addressing any undue harm to their reputations, the MGMA said.

“If the agency moves forward, it must, at a minimum, establish a process for screening libelous or slanderous comments and create a simple appeals process that allows physicians and group practices to challenge unfair or inaccurate narratives,” it said.

The AMA said it’s too early to support the proposal without more testing and explicit information on how the data would be used.

“We suspect collecting this additional information will be costly, creating an added expense practices will have to consider if they would like to continue to report the CAHPS for MIPS measure,” the AMA said.

The American College of Emergency Physicians told the CMS it strongly opposes including the questions on Physician Compare.

“Consumers reading the narrative responses online will not have any context from which to make accurate judgments—for example, the type of environment in which they experienced care, the type of caseload the facility and its providers were facing,” the emergency doctors said.

“Adding open-ended narrative questions is a little bit frightening,” Laura Wooster, ACEP’s associate executive director for public affairs, told Bloomberg BNA Aug. 24.

This in part is due to problems perceived with Physician Compare, she said. Physician groups don’t like aspects of how it’s structured, such as not comparing similar practices to one another, she said.

Developing Questions

The Agency for Healthcare Research and Quality is developing the narrative questions.

The basis is a tool called the Narrative Elicitation Protocol, Caren A. Ginsberg, director of AHRQ’s CAHPS Division, told Bloomberg BNA Aug. 29. It “prompts survey respondents to tell a clear and comprehensive story about their experiences,” she said.

Additional field testing with patients, including Medicare beneficiaries, will be implemented this fall, Ginsberg said.

The CMS said it plans to review results of the AHRQ’s testing before proposing changes to the Medicare physician quality rule.

Incorporate as Soon as Possible

Taking a different stance, an alliance of 17 local and national consumer, employer, and other organizations urged the Medicare agency to incorporate the five questions into MIPS as soon as possible.

“Open-ended questions allow patients to share nuanced and rich information that can make patient experience surveys more meaningful for quality improvement,” the Consumer-Purchaser Alliance wrote to the CMS. “For professionals, the feedback can help them understand how to effectively improve the more obscure aspects of care quality, such as communication.”

The 17 members include the AARP, the National Partnership for Women & Families, and the Pacific Business Group on Health.

Reviews like these have been successfully used by other nations’ health systems, Stephanie Glier, the alliance’s senior manager, told Bloomberg BNA Aug. 29. “We’d like to see this effort move ahead in development rather than halting work because of potential concerns.”

Patients’ comments about their doctors and other clinicians are proliferating on the internet, the alliance said. However, they may not be “representative of the clinician’s patient panel or valid given that comments are volunteered anonymously,” it said.

The questions under development by the AHRQ would be a “significant step towards capturing information from patients about what matters most to them,” the alliance wrote.

Informing Choice

Similarly, the SCAN Foundation told the Medicare agency that the feedback would help inform consumer choice. The foundation is a California-based charity focusing on older adults’ health-care needs.

Bruce A. Chernof, president and chief executive officer, told Bloomberg BNA Aug. 29 that, as a doctor himself, he understands their concerns about being represented fairly.

“That said, we live in a world where evaluation is part of everyday life,” Chernof said. “It’s not enough to judge just the technical quality of care.”

Comments about medical professionals are on a variety of websites, he said. The CMS could set up a well-managed system with filters that would remove comments that are disrespectful or inappropriate, he said.

To contact the reporter on this story: Mindy Yochelson at MYochelson@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com

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