Bedside Manners: How do we get the worst physician groups to improve?

Let’s say you accept that no physician is going to get it right 100 percent of the time.

And you accept that your health care experience is always going to leave something to be desired.

You still need to know when things have gotten so bad that you may need to call another doctor, a lawyer – or even the police – right?

In California, the range of physician performance is surprisingly wide. The top performing physician group scored 77 out of 100 on patient satisfaction in a survey by the California Healthcare Performance Information System (CHPI), while the bottom performer scored 47. That means that for the top groups, still a quarter of patients were left unhappy.

And for the worst performers, more than half weren’t satisfied. And, in fact, there were more than 40 physician groups serving hundreds of thousands of patients that scored below 60.

If you grade on a curve, very few California doctor groups would receive an “A” and many would receive a “C” or below.

Here’s the whole breakdown:

• 11 groups (7%) scored between 72 and 77 (A)
• 59 groups (36%) scored between 66 and 71 (B)
• 70 groups (42%) scored between 58 and 65 (C)
• 20 groups (12%) scored between 53 and 57 (D)
• 6 groups (4%) scored between 47 and 51 (F)

(Of course, grading on a curve means you end up with more Cs than anything else.)

I contacted some of the physician’s groups that scored an “F,” but did not receive any replies. Absent their own reflections, what can we say about these low performers and where might we find insights into how to help them improve?

1. Location counts. Only four physician groups scored 50 or below in the survey. All of them were in the Inland Empire. No physician group from the Inland Empire scored higher than 70. By contrast, the dominant location in the “A” category was San Diego/Imperial County, which had four groups that scored 72 or above. Does this mean that everyone from the Inland Empire should drive to San Diego for care? No. But it does mean that if patient advocacy organizations and regulators are looking for places to focus their efforts, they should head to San Bernardino.

2. Big can have benefits. There have been understandable concerns raised recently about consolidation in the health care industry. Are big hospital chains going to provide impersonal, bottom-line-driven care? Is Walmart going to replace your beloved family physician?

When it comes to patient satisfaction, the Consumer Reports survey shows that big physician chains may be doing a good job spreading best practices throughout their networks. Sutter Health has 50,000 employees in Northern California and a network of clinics and hospitals. It provides care for more than 11 million outpatient visits, ER visits, hospital stays, and other types of care in Northern California. It is so big, it has been sued under antitrust law. Yet, out of the five Sutter physician groups that were part of the survey, three scored an “A” grade. The large Scripps system, which has about 14,000 employees, had two physician groups in the survey and both scored an A.

This doesn’t mean everyone should look for the biggest physician group when seeking care, but it does open an opportunity for identifying tools and techniques that work and replicating them for larger segments of the population. If Sierra Medical Group is looking to improve, it should send a team over to watch what’s happening at Sutter Health or Scripps Health for a week. Perhaps these larger systems, by virtue of their size, have made more robust investments in standardization, best practices, quality control checklists and so forth?

3. Fill out those surveys. It’s annoying, right? You just want to pick up your prescription, go home and put your feet up, and catch up on Project Runway. You don’t want to fill out a survey or talk to someone on the phone who promises it will only take five minutes. But that time is truly time well spent. Whether it’s an internal survey by the health care provider aimed at helping them improve their own policies and practices, or an external survey like the one published in Consumer Reports, the information you provide can push organizations to improve. Without a report like this one, it would be hard to know whether Sutter Gould was much better than Sierra Medical. Surveying and scoring provides an entry point into what can be a dauntingly complex health system, and you are the one who can open the door.

Photo by Kevan via Flickr.