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    How residents can prepare for changes in physician measurement

    Alan L. Kaplan, MDAlan L. Kaplan, MD

    Urology Times Blogger Profile

    Dr. Kaplan is a urology resident at the David Geffen School of Medicine at UCLA.

     

    The judging and measuring started on my first day as a urology sub-intern and hasn’t let up since. Two hours into a radical cystectomy, nervous about my suturing skills, and tired from feverishly reading the night before, the attending finally directed a question my way: “Alan, who performed the lead in this 1977 Broadway classic playing on the radio?”

    Also by Dr. Kaplan - ‘Fee for service is going away’: What it really means

    The notion of being measured and judged is as familiar to urology residents as coffee. Although that process continues beyond training where patients and colleagues form and spread opinions of a doctor’s aptitude, the world of physician measurement is rapidly evolving and residents need to understand the changing landscape.

    Recently, a friend right out of training told me how devastated he was over his first negative Yelp review. The patient’s insurance didn’t cover the visit, and that brought down the doctor’s composite score to three of five stars. While online reviews of physician performance are not always that base and crude, they are becoming ubiquitous.

    Last summer, ProPublica, a non-profit producer of investigative journalism, published its version of individual surgeon quality metrics using publicly available Medicare claims data. The “Surgeon Scorecard” incorporated case volume and complications to determine which surgeons were “best” at eight common procedures, including radical prostatectomy. ProPublica has come under scrutiny for its limited data scope (most prostatectomies are non-Medicare and thus not included), its non-validated method for risk-adjustment, and the inability to capture “clinically relevant” outcome metrics (such as functional status and quality of life).

    Related: Why urology residents should care about health policy

    Despite the criticism, the Surgeon Scorecard publication attracted national attention on performance measurement and transparency, and the issue isn’t going away; ProPublica is currently working on version 2.0 of the Surgeon Scorecard. While ProPublica uses publicly available data, California-based tech startups are capitalizing on robust private claims data to refine those analyses further.

    Next: Quality of data questioned

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