Massachusetts Primary Care Practices Focus of Consumer Reports Ratings

Consumer Reports is well known as the nation's premier resource for reviews and comparisons of consumer goods and services from computers to cars and from toaster ovens to lawn mowers. But now, the consumer magazine is wading into evaluation of primary care practices with the publication of a special Consumer Reports Health (24-page PDF; About PDFs) insert in its July edition.

The insert, which was distributed only in Massachusetts, rates nearly 500 primary care practices in the state based on a comprehensive survey of patient experiences with those practices. That, in turn, has prompted both praise and words of caution from the AAFP and its family physician members.

"I see this as very much consistent with other trends we are seeing in medicine in general," said AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash. "Patient-centered medical home initiatives include patient experience surveys that provide feedback to practices to help them continuously improve their patient experience and service to their patients. The interesting part about the (Consumer Reports) initiative is that it reports out to the public as opposed to just providing feedback from patients to their respective practices."

Consumer Reports published the survey results along with an editorial and articles explaining how the information was collected, how the results were calculated, and how consumers can use the survey questions and data to become more active participants in their health care.

But the survey itself does not address clinical quality measures, such as how well blood sugar is controlled for patients with diabetes or what percentage of patients with hypertension have their blood pressure under control, Stream said. And that is a "limitation that needs to be recognized."

"I think patients need to use caution when they interpret this," said Stream. "The data do not mean their doctor is or is not practicing high-quality medicine. It is more oriented to the service aspect, which is important, but not the same."

Barbara Rabson, M.P.H., executive director of the Massachusetts Health Quality Partners (MHQP), which worked with Consumer Reports to publish the survey data, disagrees, saying the survey is "absolutely about quality."

"This is about the quality of the patient experience," said Rabson, whose organization published the data with Consumer Reports Health as part of the Robert Wood Johnson Foundation's Aligning Forces for Quality Initiative.

Better care experiences mean better health outcomes, Rabson said. Moreover, patients with better care experiences are more likely to use health care services wisely and are more likely to follow through with medical advice and treatment plans from their physicians.

But, said Stream, it is too early to determine whether the published survey will help patients or physicians. It is a pilot -- a first step -- that needs some work before it is rolled out across the country. He urged the MHQP to do a follow-up survey with patients who used the information to determine whether they found it useful and how the data can be made more helpful.

"As family physician practices are using feedback from patients to improve our service and quality, this is something that would lend itself to that same sort of continuous quality improvement methodology," Stream said.

He also called on the MHQP to conduct a similar survey on subspecialists, saying that this type of information "might influence me in terms of what subspecialists I send my patients to."

The MHQP mailed 180,000 surveys to Massachusetts residents who are commercially insured and had seen their primary care physicians within the past 12 months. They received 47,565 responses from adult patients and 16,530 responses from the parents of children who are patients.

The published survey is made up of 20 questions that correspond with six broad categories covered in the survey. Each of the questions represents a performance measure rated on a scale of 0 to 100, and the scores then are divided into four categories, with four being the highest score.

The survey found, for example, that 86 percent of the patients at Family Medicine Associates on the North Shore would highly recommend the practice to others. The family practice also scored in the highest 15th percentile for how the 10 physicians in the practice communicate with patients, the treatment of patients by physicians, and whether the practice provides patients with timely appointments, care and information.

Family physician Hugh Taylor, M.D., one of the physician owners of Family Practice Associates, describes himself as a fan of Consumer Reports and says he has no objection to the publication of the data.

"This is what is called transparency," he said.

Taylor said having this type of data published in Consumer Reports is preferable to having nonscientific data about physicians published on random websites. But like Stream, Taylor said the survey would give a more accurate picture of primary care practices by including quality data.

Dennis Dimitri, M.D., vice chair and clinical associate professor of family medicine and community health at the University of Massachusetts Medical School and the University of Massachusetts Memorial Medical Center in Worchester, voiced similar opinions, saying the survey represents a "reasonable move toward a better understanding of how patients view their doctors and the quality of interaction between patients and physicians."

"I think it probably helps physicians better understand how they are viewed by their patients and can have some positive impact on us," said Dimitri. But like Taylor and Stream, Dimitri described the lack of quality measurements as a weakness of the survey.

"Some of the data in this report are much more of a subjective nature, which makes it a little harder to know how to respond to it," he said.