Can You Trust Online Doctor Rankings?

(CBS)  For years, Ved Kawatra had excruciating pain in her shoulder: arthritis had taken its toll. Medications, therapy, nothing worked. She needed a total shoulder replacement. To choose an M.D., she and her husband turned to their PC.

"We decided to go on the Internet and look for surgeons, doctors who do shoulder replacements," said Ved's husband, Mahendra Kawatra.

Finding a surgeon proved difficult and confusing; first of all, there was an overwhelming amount of information. But there was also something the Kawatras had never seen before: The doctors were rated by their insurance companies, reports CNN's Dr. Sanjay Gupta, a CBS News contributor.

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Read more from our partner in reporting this series, BusinessWeek.

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A growing number of insurers are placing doctors into different levels or tiers. The higher the tier, the more the company will reimburse. A patient might have a co-pay of $35 to see a Tier-3 doctor, but would pay just $15 to see a Tier-1 doctor.

"I have no concerns with rating the doctors as long as I should know, the patient should know, what they are being rated at," Kawatra said.

She makes a good point. One Web site uses stars to rank doctors and it's clear which doctors score highest. What's not clear is why. Patients often don't know and many physicians say they, too, have no idea how they're judged.

"What we don't like is when the tiering system is used that is not transparent, that we cannot see the data, we can't understand how it was created," said Dr. Richard Parker of Beth Israel. "And frankly, we can't understand why we were put in the tier we were put in."

Parker says he's in fact ranked differently from plan to plan, which is frustrating and confusing.

Insurance companies say they rate doctors based on quality and cost.

"That sounds very good. The problem is quality is very hard to measure," Parker said. "If a diabetic patient has his or her blood sugar measured several times per year, that's easy to measure. But many of the other things that patients come to the doctor for are just not easy to measure."

"The bottom line is that the only way for things to get better is to measure them. If you don't know how well you're doing, you have no way to see over time if you're improving or things are getting worse," said America's Health Insurance Plans spokesperson Susan Pisano.

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Second Opinion: Medicine Online
Read part I | Part III

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And it's not just insurers, but patients who are judging doctors.

On DrScore.com, patients can rate things how their doctors treat them, as well as the staff and punctuality. BookOfDoctors.com asks patients 14 questions to rate their doc. And RateMDs.com allows patients to both grade their doctors - and add their own comments.

In the end, the Kawatras chose not to go with the doctors recommended by their insurer, but instead relied on their own online research.

[lasikexpert]

Friday, February 05,2010

James R. Donahue
Caulfield, Davies & Donahue, LLP
Post Office Box 277010 Attorneys for Hanson
Sacramento, CA 95827-7010 Hagele v Hanson 06AS00839

re: Demand for Immediate Removal and Cessation of Statement:
Glenn Hage1e's attorney files a motion to withdraw from representation based on Hage1e's criminal activity

Mr. Donahue,

At the Internet webpage accessible through Unique Resource Locator (URL)
http://www.******.com/doc/*********/Jon-Sasser-*****-*-*****-**-*******-****-**************-
**-Glenn-Hagele-*****-**-******-*-********-********* your client has published or caused to be published with a copy of a Motion For Leave to Withdraw as Counsel, filed in The General Court of Justice Superior Court Division, Wake County, North Carolina, case 7CVS19854, the headline and body copy "Glenn Hage1e's attorney files a motion to withdraw from representation based on Hage1e's criminal activity"

The relevant motion states the grounds are under North Carolina Rules of Professional Conduct 1.16(b)(3), 1.16(b)(4) & 1.16(b)(5) (1997). Rule 1.16(b)(3) reads; "the client insists upon pursuing an objective that the lawyer considers repugnant, imprudent or contrary to the advice and judgment of the lawyer". Rule 1.16(b)(4) reads; "the client fails substantially to fulfill an obligation to the lawyer regarding the lawyer's services and has been given reasonable warning that the lawyer will withdraw unless the obligation is fulfilled". Rule 1.16(b)(5) reads; "the representation has been rendered unreasonably difficult by the client". None of these grounds make any accusation or inference to criminal activity of any kind.
(http://www.aoc.state.nc.us/www/public/aoc/barrules. html)

Demand is herewith made that Mr. Hanson immediately stop publishing the false statement that my counsel has moved to withdraw from representation based on criminal activity and that Mr. Hanson take prompt corrective action, absent which I shall have no choice but to seek appropriate redress with the Court.

Mr. Hanson has made a written statement of fact, rather than opinion, that violates my constitutional rights, places me in a false light, tends to injure and in fact does cause injury to my occupation and character, and/or exposes me to hatred, contempt, ridicule or shame.
Moreover, Mr. Hanson's written statement constitutes defamation per se, which causes me substantial injury and interferes with my ability to conduct my business.

I herewith demand of your client the following:

1. Immediately remove or cause to be removed those portions of all publicly accessible Internet web pages he controls that include any statements stating or inferring allegations of criminal activity against me by my counsel Jon Sasser, including, but not limited to, the statement published at URL http://www.******.com/doc/*********/Jon-Sasser-*****-*-*****-**-*******-****-**************-
**-Glenn-Hagele-*****-**-******-*-********-*********.

2. Immediately remove or cause to be removed any statements by Mr. Hanson stating or inferring allegations of criminal activity against me by my counsel Jon Sasser from the URL http://www.******.com/doc/*********/Jon-Sasser-*****-*-*****-**-*******-****-**************-
**-Glenn-Hagele-*****-**-******-*-********-*********
(i.e. the portion of the URL "Jon-Sasser-*****-*-*******-**-********-****-
**************-**-Glenn-Hage1e-*****-**-Hagele-*-********-********").

3. Immediately remove or cause to be removed from all publicly accessible newsgroup, bulletin board, or chat room statements by Mr. Hanson stating or inferring allegations of criminal activity against me by my counsel Jon Sasser.

4. Immediately privately retract all statements by Mr. Hanson stating or inferring allegations of criminal activity against me by my counsel Jon Sasser, that were distributed via email, conventional mail, or any other private means.

5. Refrain from publishing, republishing, or communicating in any manner to any third party the inference or statement that my counsel Jon Sasser has made allegations of criminal activity against me.

If I do not receive by 5:00pm Tuesday 9 February 2010 a confirmation from you that Mr. Hanson's statement has been removed as defined above, I will seek injunctive relief from the Court that Mr. Hanson refrain from making this defamatory statement.

Thank you in advance for your prompt attention to this matter.

/s/
Glenn Hagele

[BrentHanson]

Glenn Hagele's Criminal Conduct Cited in Attorney's Motion to Withdraw from USAEYES/CRSQA Lawsuit

Glenn Hagele filed a frivolous lawsuit against LASIK patient Dr. Lauranell Burch in North Carolina in December 2007. On December 14, 2009 Jonathan Sasser, the attorney for Glenn Hagele, filed a motion to withdraw from representation and cited the following provisions of North Carolina Rules of Professional Conduct: 1.16(b(3) 1.16(b)(4) 1.16(b(5), The portion of the North Carolina Rules of Professional Conduct which Jonathan Sasser cited is:

Rule 1.16 Declining or Terminating Representation

(a) Except as stated in paragraph (c), a lawyer shall not represent a client or, where representation has commenced, shall withdraw from the representation of a client if:

(1) the representation will result in violation of law or the Rules of Professional Conduct;

(2) the lawyer?s physical or mental condition materially impairs the lawyer?s ability to represent the client; or

(3) the lawyer is discharged.

(b) Except as stated in paragraph (c), a lawyer may withdraw from representing a client if:

(1) withdrawal can be accomplished without material adverse effect on the interests of the client; or

(2) the client knowingly and freely assents to the termination of the representation; or

--> (3) the client persists in a course of action involving the lawyer?s services that the lawyer reasonably believes is criminal or fraudulent; or

--> (4) the client insists upon taking action that the lawyer considers repugnant, imprudent, or contrary to the advice and judgment of the lawyer, or with which the lawyer has a fundamental disagreement; or

--> (5) the client has used the lawyer?s services to perpetrate a crime or fraud; or

Read the document at http://www.lasikfraud.com/crsqa/lauranell_burch/legal_docs/2009-12-December/2009-12-14_sasser_motion_to_withdraw.pdf

For more information about Glenn Hagele, visit the following web sites:

http://www.lasikpimp.com
http://www.theglennhagelereport.com
http://www.usaeyes-fraud.com

[sfeldman5]

When the Kawatras researched doctors online, they faced a plethora of doctor ratings, rankings and rantings. I created DrScore.com, a site specifically developed to enhance the quality of patients%u2019 healthcare experience.

DrScore.com helps doctors get valuable feedback from patients and lets patients freely get information about doctors. Nearly 1,000 doctors around the country support use DrScore to get feedback from their patients. DrScore patient satisfaction reports provide doctors a wealth of information about their practice, information they use to improve their services. As a practicing dermatologist, feedback from my patients was tremendously instructive in helping me strengthen patient relationships. I think all of our participating offices would agree wholeheartedly that the feedback from our patients is critical to our success as doctors.

Plus, consumers like the Kawatras can easily access DrScore.com at no charge and see overall ratings for physicians searchable by name, zip code and/or specialty. Our database also includes basic information about more than 800,000 physicians nationwide. DrScore.com maintains physician ratings for all doctors in our database, not just those who pay to receive our reports. To help keep our data up to date, patients can add physicians who aren%u2019t in our database.

Doctors and patients want the same outcome %u2013 to get better. DrScore.com helps doctors and patients collaborate on the path to good health.

[gasmask1]

You can bet if the Insurance world is involved there is a crime being committed.

[timothyone-2009]

Doctors who do fewer expensive procedures are rated higher. It''s not about quality, but about money, money, money, money, money, money, and more money! Oh... I forgot... it''s also about cash!

[brainteaser2]

No you cannot trust online doctor polls. They are a combination of popularity contests and more meddling by insurance companies. There has to be an element of trust in a doctor-patient relationship

[whatabreeze]

No disrespect to anyone at CBS (you truly are my favorite) but why on earth would anyone consider an on line physician when there is just as much positive and negative in the open field. You can see what your getting and in regard to the monetary issue, there is "Always a cost in doing business." G-d Bless...

Breeze and Franky "Boston Terrier Neuro Service Companion."

"Founder, Central Pontine Myelinolysis Foundation"

[earache4]

Can You Trust Online Doctor Rankings?

I sure hope so! I built my whole Fantacy Hospital League Team based on those rankings!

[lasikexpert]

I work with a nonprofit patient advocacy that evaluates Lasik doctors based on a detailed patient survey. To attain certification by our organization, Lasik surgeons must be in the top 90th percentile of their peers. We make the survey available online so all may see what we ask patients.

Transparency with any healthcare provider evaluation is required. The needs and motivations of one group may not be the same as another. A patient may not be the least bit concerned if a doctor is the most cost effective, but would be very interested if the doctor%u2019s results are among the best.

Evaluating healthcare provider outcomes can be very challenging and tends to be an unwieldy and expensive process. Someone will need to pay for that process and ultimately it will be the consumer. This creates a strong disincentive to participate in any broad evaluation program.

For better or for worse, it seems that the primary process by which poor doctors are identified is malpractice litigation. Even that can be an inadequate yardstick as many will pay off a small amount as a nuisance, yet the records still show a successful malpractice claim.

Proactive healthcare provider evaluation is a difficult process fraught with limitations, however informed patients demand this kind of analysis and industry, or nonprofits such as ours, needs to provide healthcare consumers with this information.

Glenn Hagele
Council for Refractive Surgery Quality Assurance
www.USAEyes.org

[tngreen]

I would tend to be most wary of those doctors who received high ratings from insurance companies, because it would tend to indicate that they put keeping costs down above patient well-being. I would much rather see a website where patients themselves rate their doctors on accessibility, listening skills, knowledge, performance of the doctor''s staff, and such. The interests of insurers is usually at direct odds with those of patients--maybe we should use these sites to identify doctors to AVOID.