By Pat Whelan, Chief Operating Officer, Denniston Data Inc.
There is more to be gained by the release of Denniston Data’s Provider Ranking System, than the ability of users to find the most high-performing physicians and providers in their area or nationwide, though certainly, that is important. Studies have shown, and we have already written about and documented, that experienced doctors have better outcomes than doctors who are less experienced. (Denniston, 2021)
Having Provider Ranking System (PRS) integrated into a Self-Insured Employer’s Benefit Package, or an Insurer’s or Third-Party Administrator’s Network to identify those most experienced, by service performed, is just the first step of Denniston Data’s mission and core purpose: to improve the efficiency and effectiveness of the U.S. healthcare system. On a higher level, the very existence of an objective, transparent and annually updated ranking tool like PRS, serves a greater good. It raises the bar for all healthcare providers – knowing they are being ranked among their peers – to focus on what they do best, fine tuning their skills to do even better, do it more often, and reach optimum proficiency. A ranking system is a means for setting standards. It is a fair way for all providers to see how they compare to their peers in terms of how often they perform each test or procedure; a yardstick, if you will, that helps them measure themselves against the pool of others who practice within their area of specialty. After all, measuring tools of some form are necessary and utilized in every aspect of our lives: clocks, odometers, thermometers, scales, rulers, compasses, money; they are, in fact, essential to everything we do in science, industry and commerce. Clearly, in healthcare, there are any number of measuring or diagnostic tools to determine how a patient compares to “normal” – stethoscopes, blood tests, stress tests, EKG’s, to name a few. A patient can learn relatively quickly if they have deviated from the norm. Not so easy for a provider. Once a provider is out of school where he or she is tested and rated and ranked on performance, there is little available to help assist him to gage his experience level and expertise against others. According to the American Board of Family Medicine (ABFM), “Public reporting may affect quality through transparency, consumer choice, and reputation. Making quality performance results publicly available provides transparent information about variations in performance. Transparency enables consumers or their agents to use quality reports to choose health plans, hospitals, and doctors. Transparency and consumer choice also increase the motivation of clinicians, hospitals, and systems to improve performance because of concerns about reputation.” (McGlynn, 2020)
“Quality measurement is fundamental to systematic improvement of the healthcare system. Whilst the United States has made significant investments in healthcare quality measurement and improvement, progress has been somewhat limited…Numerous issues have limited improvement, including lack of alignment in the use of measures and improvement strategies, the fragmentation of the US healthcare system, and the lack of national electronic systems for measurement, reporting, benchmarking and improvement.” (Burstin, 2016)
“Public policy can support clinicians’ intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care.” (Berenson, 2015) Provider Ranking System can serve as a guideline for providers themselves to see how they rank, how their practice ranks, how their outcomes rank. “Public reporting permits health professionals and provider organizations to see how their own performance compares to peers. In that way, it supports non-financially based attributes such as pride, concern about reputation, and desire for self‐improvement grounded in professional duty to act in patients’ best interests, thus encouraging intrinsic motivation.” (Berenson, 2015) It is essential, however, to note that because public reporting can affect reputation, the data reported needs to be based on evidence. That is why PRS relies only upon actual data. No opinions, no judgment, no advertising induced bias. PRS data: Transparent, Objective, Real.
A few weekends ago we were at our vacation condo in California. We had not been there in almost a year, due to COVID. We were pleased that some neighbors asked us to bring our own cocktails and join them around the community pool as they watched the sunset and shared conversation. Clearly, this was a ritual they enjoyed most weekends, and we were happy to be included. As we were exchanging pleasantries, one of the folks asked about our new business. I started talking about Provider Ranking System. “In a nutshell, it ranks providers strictly based on volume by procedure – how many times in each year a provider has performed a particular service… based on the simple, but proven premise, that the more someone does something, the better they do.” Suddenly, one of our neighbors grabbed her iPhone and piped into the conversation, “I’m a provider. I want to see how I rank!” She immediately asked me for the URL to our site and signed up for a trial. She started at the Provider Search section and keyed in her NPI (National Provider Identifier). (As an aside, if she had not known it off the top of her head, she could have just searched on last name, first, and/or city, state, and zip.) Her NPI, name, Credential, Type of Provider, City, State and Zip came up. An icon was included which she clicked for “Provider Detail” which brought her to information about her practice, the number of procedures she performs, the size/growth of her practice, billable and allowable aggregate dollars for the year and patient demographics. That was for 2018 (the most recent year of data reported). She could change the year and see a snapshot of this same information for every year from 2012 on. Most importantly, her Provider Ranking information was listed. Interestingly, of the dozen or so procedures she performs, she was in the top half of providers for most of them and the top quarter for several, for the entire country. Plus, she was even #1 for one of her procedures in her local area. That is a record any provider could be proud of, and I told her as much. Still, as our cocktail hour was ending, she thanked me again for letting her try PRS and was happy that her rankings were above average. “But,” she concluded, “now that I know how I how I compare with other colleagues, I want to do even better!” It was clear to me that the gleam in her eye was not from the half-finished pomegranate martini she held in her hand. It came from a fierce determination to be number 1. Seeing her rankings motivated her to improve even more. I believe that most providers would react similarly.
To make significant improvements in US health care, “a closer connection between measurement and both evolving national data systems and evidence‐based improvement strategies is needed.” (Burstin, 2016) There is an expression I heard a long time ago which has inspired me for years: “The cream always rises to the top.” In fairness to providers – how can they rise to the top if they do not know where the top is? Provider Ranking System can help them to find the top, reach for it and maybe even surpass it. The result? A win-win for all – providers, patients, insurers, and the entire U.S. healthcare system.