Stop the Doctor, Medical School and Hospital Beauty Pageants

Former Miss America ,Bess Meyerson, died in 2015. Her death reminded me of the many summers I spent with my family in Atlantic City. Among other summer jobs, I sold newspapers on the beach in front of Steel Pier and, when the Miss America pageant was in town, it was good for business. You can read more about the last diving horse in America here.

It's doctor beauty pageant season again.

So, doesn’t that make it a wide popularity contest?

Even the sponsors admit that, in some respects, they do. They hope that doctors give them careful, responsible answers, but there’s little they can do to stop them from recommending their skiing buddies. Using the list is a lot like going to your doctor and asking for a referral. The difference is that we’re asking a lot more doctors than you’d ever have the chance to—and more than 1,530 responded this year.

Doctor, hospital, and product (testimonials) beauty pageants might be good for business, but not good for patients. Doctor beauty pageants, those contests and surveys you see in regional magazines, in flight magazines and national publications touting the "best" whatever, are misleading, typically based on invalid criteria and data, and distract us from defining what really matters, i.e. who is delivering the most stakeholder defined value.

Does it really matter if you are not chosen to be a "best doctor"?

I see some basic problems with these rating systems:

1. They are marketing and reputation driven not outcomes data driven
2. The data is not relevant, accurate or meaningful i.e. garbage in, garbage out
3. The process is doctor centric not patient centric.
4. Hospitals have been nationally ranked by popular media sources such as U.S. World News & Report for decades, but the quality measures used to determine these lists may be missing one key domain––health equity.

Here’s a look at why the contention that medical school rankings remain a “beauty contest” has some merit and why medical students advise pre-meds to look beyond the best-of lists to find the right fit.

But does your Best deliver? Not really, according to a recent paper. ?Surgical outcomes vary widely across hospitals affiliated with the?US News & World Report?Honor Roll hospitals. Public reporting mechanisms should provide patients with information on the quality of all network-affiliated hospitals. Networks should monitor variations in outcomes to characterize and improve the extent to which a uniform standard of care is being delivered.

Here is an example. Sounds good, huh? However, as noted on the website, "by including the documents on this website, the American Heart Association does not represent that they are complete, accurate or efficacious, or that they follow all of the American Heart Association guidelines for secondary and primary prevention of cardiovascular events or stroke."

Value should be measured as the quality of a given outcome per unit price. We don't do it now because we have not all agreed to the outcome criteria, we don't have the systems in place to do it, there are many interests who are resisting the public disclosure of such information and we have a byzantine, opaque healthcare pricing system making it impossible to find out what something really costs.

Value based care and bundled payments has introduced a new sense of urgency when it comes to measuring quality of care outcomes. For example, how do we measure the quality of surgery done in free standing ambulatory surgical centers? Taking it one step further, stratifying surgeons into quality percentiles will be even trickier and meet more resistance since every surgeon I know, including me, thinks they are from Lake Wobegon where everyone is above average.

In addition, like the news magazine ranking of universities, there is a policy of mutually assured destruction, reminiscent of the cold war. No one health organization wants to unilaterally withdraw for fear of losing a competitive advantage or be destroyed. As a result, when the polls open, there is a full court marketing press with email blasts and notes reminding hospital staffs to get out the vote.

Here's how one group rated the raters and the grades where not good.

Instead, we should be giving patients the information they need to make a smart choice:

1. How many procedures has the doctor done in the past year?
2. How much do they charge for elective, commoditized services like blood tests?
3. What is their appointment availability?
4. What have been their death and complication rates?
5. What hospitals do they use and how do those hospitals rate?
6. What eCare technologies do they use?
7. Have they ever been disciplined by an oversight or regulatory agency?
8. Are they within your network?
9. What post-acute care facilities do they refer to if necessary and how to they rate?
10. What is their on-call coverage arrangement?
11. Do they work in facilities that have awarded third party accreditation that includes standards for not just structure and process, but outcomes as well?
12. Do they participate in programs that rate individual surgeons for a given procedure, not just the hospital or facility for aggregate categories of procedures?
13. If a rating system measures outcomes, are they valid and applicable to an individual patient need treatment for a specific condition, like total knee replacement, not just orthopedic surgery
14. What data source was used to generate the results? Medicare data? Self-reported data?
15. When objective data is not available to measure outcomes, for example, cases done on patients under sixty-five in an independent ambulatory surgery center, what are some other surrogate measures or proxies that patients can use?

16. Given the low levels of patient sick care literacy, what is the best way to inform and educate patients about the pros and cons of diverse ways medical and surgical outcomes are being measured and reported?

17. How to we separate patient experience outcomes from quality-of-care outcomes and report them separately, given that one is not related to the other?

18. How do we use analytics and data science to make better sense of it all?

19. How do we create incentives for payers, clinicians and patients to reduce the variations in outcomes?

20. How do we create personalized, value factor preference driven decision trees for patients e.g., those who would be satisfied with "good enough" but excel in experience, service, or convenience?

Doctor beauty pageants are annoying, invalid, create resentment in doctors who weren't chosen, and mislead patients. Some of the chosen are, in fact, no longer seeing patients, retired, or relocated. I am one of them.

Even the promoters of these beauty contests admit they are just popularity contests.

Some might even no longer be alive.

A system for allowing patients and employers in the United States to compare health services on the basis of price would be inadequate. To make such a tool worthwhile, quality comparisons are also essential. This article offers three steps that would put the country on a path to create such a system: 1) incentivizing the adoption of patient-centered quality measures at the condition level, 2) identifying clinicians, such as surgeons, who meet a minimum volume threshold for common procedures, and 3) ensuring the accuracy of clinician directories.

Many organizations are moving towards making financial claims, prices, outcomes and demographic data more available and transparent so patient- consumer-customer- clients can vote for themselves. U.S. News & World Report is revamping some elements of its law-school ranking, capitulating to pressure after deans at more than a dozen top law schools publicly challenged the value of the closely followed list.

Some medical school Deans have read the memo. Five of the nation’s top-ranking medical schools will?no longer be participating in U.S. News & World Report’s “Best Medical Schools” survey?over concerns about the “perverse incentives” and “harmful impact" the annual rankings may have on higher learning priorities. ?The medical school deans and the activists pushing them, however, apparently won’t be satisfied until test scores and grades are totally eliminated from the rankings, replaced by a commitment to anti-racism and diversity, equity and inclusion, which are less easily quantified.

I for one hope it happens sooner than later because the swimsuit competition was never my best event.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs

Updated 1/2023

Hand made in Denver