I ranked my kids last weekend and let’s just say 4 of the 5 kids stormed out of the room, arguing with both my methodology and motives. That I gave my daughter Sophie 20 bonus points simply because I like her best didn’t go over well. The rankings have consequences – fewer chores, better snacks to the top ranked, fewer TV remote privileges to the bottom tier. Rankings matter, maybe not so much in college sports where post-season committees at times pick tournament teams based more so on popularity and history than performance; but they matter, and increasingly in healthcare. Jodie, 58, told me she’s now seriously considering knee surgery now that she has grandkids and during a flight back home to Virginia recently she picked up US News & World Report – ‘he looks good,’ she muttered, as she began to tear out the page before folding it tightly and placing it into her knapsack. ‘I want the best,’ Jodie said. Consumers tend to make healthcare decisions based on what they see, hear and know – 306 out of 412 in a poll we did this time last year said they rely mostly on ‘word of mouth’ when it comes to healthcare, although about the same number were ‘getting tired of having to call their PCP for approval’. Those, like Jodie, without local connections or a healthcare degree tend to be more willing to rely on rankings and go out of the state to find the best, even if ‘best’ is defined by an arbitrary list. Not that the magazine’s annual rankings are arbitrary, but there are those who see these lists as more marketing ambition than medical recognition; 59% surveyed said they discount them, 35% said they assumed they were based at least on some level on the success and reputation of the physicians. Behind the scenes, managed care insurers are trying to create their own rankings that score and rank physicians. All the key measures used to evaluate providers are being evaluated though some aren’t and some seem to perhaps be countermeasures. One—capacity to assess, diagnose and treat depression or other behavioral health challenges—seems to be missing from all or most of the ranking criteria, though I suspect we’ll see more recognition for providers who can screen for and identify depression. Other payers tend to measure certain outpatient providers based more so on utilization or visits than on outcomes. In case you missed it, here are results of our own poll of both consumers and insurers on the emerging trend of ranking providers and tiering networks as a means to drive patients to the best, whatever ‘best’ means. Click here
