For the first time, how well each of 552 physician practices in Minnesota manage their patients with diabetes and heart disease is now scored in a special edition of September's Consumer Reports, with each practice group assigned rating from a low of "1" to high of "5."
"I'm sure many of the practice sites in Minnesota that were given 1s and 2s are worried today, and this may not be a good week for them," said John Santa, MD, director of the Consumer Reports Health Rating Center.
He adds, however, that the data has been collected since 2002 and reported publicly with updates on the Minnesota Community Measurement website since 2004 under contract with the Minnesota Department of Health, so these clinics had plenty of time to raise their scores.
And while the information was not risk-adjusted to reflect patient income, health literacy, race or ethnicity, those factors aren't an excuse because some practices with that population of patient mix scored very high while some scored very low, he says. Likewise, practices treating patients in more affluent communities also had wide variation in their scores.
The charts, which use data that Minnesota law requires physicians to report to a Minnesota agency, looked at what percentage of each practice's patients achieved certain quality thresholds. For diabetes, for example, a clinic received a high score of "5" if 50% or more of its patients in treatment had achieved an A1c blood glucose control level of less than 8, and had high scores in four other measures.
Other data reflect the percentage of a practice's patients with either diabetes or heart disease who have blood pressure levels of 140 over 90 or better, take a daily low-dose aspirin, have an LDL cholesterol count below 100 milligrams per deciliter, and who don't smoke.
Thirty-seven practices earned Consumer's Reports highest rating of "5" in measures of care for both diseases. Of those, 11 are in the Park Nicollet group, eight in the Allina Medical group and six in the Entira Family Clinics.
Sixty-six practices received the lowest score of "1" for diabetes care measures, 50 got a "1" for cardiovascular care and 24 received the low score for both conditions.
Some 4,440 adult primary care physicians, including endocrinologists, geriatricians, and cardiologists practicing in solo or group practices or clinics were included.
The issue of patient compliance with physician recommendations has always been a sticky one. But research shows that when physicians approach topics with their patients carefully, offer constructive and persuasive tools, and reminders or regular phone checks, they may have better luck getting their patients to understand the importance of getting it right.
"I don't think that there's any doctor who would dispute that these are important to get done and that you can get them done," Santa said.
Santa explains that Consumer Reports adapted its familiar scoring system of red, black, or grey bulls-eyes for each condition, diabetes or heart disease, in order to make more people aware that the data exists.
The system uses an "all-or-nothing" methodology, in which a physician practice could only get a certain numerical score if it achieved performance thresholds for each question in each disease category.
The Minnesota project is the second in a series under a Robert Wood Johnson Foundation grant to Consumers Reports to make data available on healthcare quality for consumers.
The first was a partnership with Massachusetts Health Quality Partners in which Consumer Reports revealed patient experience scores for 500 primary care physicians. The third and last one, to come early next year, will score providers in Wisconsin on the extent to which they provide appropriate preventive care.
Asked if consumers should care about this scoring system if they haven't been diagnosed with and are not at risk for diabetes or cardiovascular disease, Santa and Jim Chase, president of Minnesota Community Measurement say they should.
"Groups that have a tendency to do well do well across a number of measures," Chase says.
While that isn't always 100% true, it's true enough, and "says a lot about the kinds of support that these practices provide their patients."
Lyle Swenson, MD, president of the Minnesota Medical Association and a cardiologist in St. Paul, says his group is, in general, "okay with the (Minnesota Community Measurement) process. But it's an interesting twist to have a commercial enterprise like Consumer Reports report on this."
Swenson adds that because the magazine is taking just two treated conditions, diabetes and heart disease, to score on just a few measures, his group has concerns that "it certainly doesn't give the entire picture when patients are trying to make decisions about where they get their care."
Consumer Reports and the Robert Wood Johnson Foundation selected Minnesota and Wisconsin for two of the projects because according to a report from the Agency for Healthcare Research and Quality, Minnesota "has the best performing health-care system in the country, just edging out Wisconsin," the magazine article accompanying the scoring list says.
"The same analysis showed that the state (Minnesota) was rated above average in all but one measure of diabetes care, and average or above average for heart disease measures."
Because Minnesota is already a top performer, the article advises patients being cared for by low scoring doctors not to fire them right away.
"Don't panic—at least not until you've discussed the results," the article says. "For one thing, Minnesota ranks first in the country in many measures of health care and is above average in most aspects of diabetes and cardiovascular disease care, so a practice that scores below average in Minnesota might still be average or better compared with practices elsewhere in the country."
Santa says that the Minnesota database contains data on physician quality of care for numerous conditions, including asthma, colorectal cancer, depression and the use of health information technology. But it decided to go with diabetes and heart disease since so many patients have those diagnoses, or conditions that place them at high risk.
Consumer Reports say that the physician scoring editions of the magazine reflect a new era for transparency and are especially relevant because they mirror all-payer data, based on actual care, rather than Medicare data, which is based on claims.