Physician Ratings Services Still Come Up Short

The company that puts out the Zagat guides to restaurants and leisure activities licensed its name to WellPoint, one of the largest U.S. insurers, about a year ago. Now WellPoint is posting reviews of physicians by WellPoint members for the use of its other members across the country, plus members of one other plan.

WellPoint's Blue Cross and Blue Shield plans include about 35 million people in 14 states. The Zagat-themed reviews are currently available to 2 million people in California and Ohio, as well as 3.7 million members of Blue Cross Blue Shield of North Carolina, which is not affiliated with WellPoint. The company intends to expand the service to other affiliates and independent Blues plans.

One physician interviewed by The New York Times expressed a dim view of the ratings service, noting that health care quality cannot be rated the same way a restaurant meal is. Another pointed out that consumers have a "subjective" view of how good a doctor's care is.

In another piece about ratings services in general, physicians made similar comments. One doctor saw these services--which include Healthgrades, Angie's List, DoctorsScorecard.com, and part of Revolution Health--as a popularity contest that reveals little about quality. But another physician said that patient preferences do show something about customer service--an area in which physicians have long been deficient.

The Angie's List survey asks patients whether the office staff was helpful and courteous, whether the waiting room was clean and comfortable, and whether the physician listened to the patient and explained things well, among other questions. All of these issues are important to the patient experience, but they don't tell you anything about the doctor's clinical or diagnostic skills. Neither does the name of the medical school that the physician attended or whether he's board-certified (most physicians are).

In light of this latest consumerist thrust by insurance companies, it was rather humorous to see a pair of New Jersey hospital systems duking it out over which one had more "top docs." A Camden County Superior Court judge heard arguments in a lawsuit by the Cooper Health System against Virtua Health, a South Jersey competitor. Cooper alleged that Virtua had based an advertising campaign on the erroneous claim that it had "twice as many" top physicians as any other health system. Virtua said this information came from an "independent study," but later admitted in court that it had been based on "best-doctor" lists that ran in several area magazines.

These "top doc" lists form the basis for articles and lucrative advertising in city and regional magazines all over the country. They're based on polls of local physicians, who are asked which doctors they'd go to or send family members to. Not only does this involve a fair amount of backscratching, but few physicians actually know very much about the clinical quality of the doctors they refer to. In most cases, they depend on personal connections, the reputation of the physician, and their own experience in referring patients to that doctor.

So, once again, patients are in a data-free zone when they try to find a good physician. Word of mouth seems to be as reliable as anything else.