A leading internist recently confided a dirty little secret about the medical profession. He told me that while he’s referred thousands of patients to various doctors over his 20-year career, he has “no idea if any of them are any good.”
Twenty years of blind referrals. Let that sink in for a moment.
Patients think that if their doctor recommends a specialist, the specialist has their provider’s seal of approval. The truth is, most of the time, your doctor is just guessing. Physicians would never prescribe a drug or a procedure to a patient without knowing everything there is to know about what they’re recommending. But when it comes to referrals, providers haven’t been given the tools to make the best decision for their patients.
That’s not to say these tools don’t exist. Physician performance transparency tools are available and are currently being used by some health systems to help keep track of physician performance quality. But the information is not being filtered down to the physicians. It’s like asking a doctor to diagnose a patient, but telling her she can’t use blood tests, X-rays or even a stethoscope.
The consolidation of healthcare systems means that primary care physicians have more choices than ever before when it comes to referring their patients to incredible specialists – sometimes thousands of more options. Unfortunately, most health systems don’t even update their rosters, let alone provide detailed information about who does the best laparoscopic heart valve replacements.
My internist friend, who is also the head of a large ACO, told me that this lack of information keeps him up at night. And with good reason. Decades of peer-reviewed studies have found a relationship between experience and outcomes. Earlier this year, U.S. News and World Report found knee-replacement patients at low-volume hospitals had double the national average risk of death and patients who underwent hip-replacement at low-volume hospitals faced a 77 percent higher risk of death.
As high as the stakes already were for doctors, they’re about to get higher. The shift from fee-for-service to value-based care means that PCPs will be held accountable for the quality of the referrals they make. If the internist sends their patients to specialists with high readmission or complication rates, soon they will be financially dinged. But just raising the personal stakes doesn’t make it any easier for doctors to find the right referrals.
Sure, they now might take a few extra minutes to research a specialist on Google, Yelp, and the same ineffective tools the rest of us have. That doesn’t mean the results will be any better than what we can find on our own.
Physician performance transparency tools enable providers to make the informed referrals their patients deserve. They are tools – just like diagnostic tests and medications – that doctors need to help fulfill their promise to “do no harm.” And doctors are demanding them.
Health systems and health plans are starting to listen to their physicians and embrace performance transparency a bit more. One health plan on the East coast, for instance, is giving their PCPs raw performance data and asking them, essentially, to just refer to the “good” specialists.
The health plan’s approach is better than nothing, but there are far better tools available today. Isn’t it time our doctors get a chance to use them?Read this article on LinkedIn »