Transparency in Massachusetts: A Success and a Challenge

Today, Massachusetts Health Quality Partners releases its fifth annual report on quality of medical groups across the state.   The quality data is derived from claims data from most of the health insurers in the state (not including Medicare or Medicaid).  MHQP also reports on patient experience data based on an annual survey.  MHQP’s database is searchable by name and zip code. 


Patients in Massachusetts can see quality and patient experience metrics for medical groups. This makes the data more likely to be statistically significant, although some critics would rather see this data at the individual physician level.  The value of a report at the group level is especially high for practices with high levels of integration and cross-coverage.  MHQP has established dialog with physicians, health plans, and other stakeholders, and gives providers a cycle to review and comment on data before it is publicly released. This takes time and energy – but increased “buy-in” from the provider community makes it more likely that the public disclosure will actually change practice. 


MHQP will be developing and implementing the state’s quality and cost website over the coming months.  Data on cost of care will be an important complement to the current public disclosure.


The Boston Globe had a front page article yesterday suggesting that cardiologists in Massachusetts avoid the “tough” cases of heart vessel blockage for fear that these cases would adversely impact their reported mortality rates.   (In an ideal world risk adjustment would fully address this concern – but we don’t live in an ideal world!)   The article was illustrated with a photograph of a man who had an angioplasty despite the fact that he was in a coma – he recovered and is shown with his wife walking the family’s three dogs.


This is a tough public policy issue.  There is very ample evidence that public reporting helps ease “bad quality” providers out of the system, and lowers the risk of death or morbidity for the “average” patient.  However, there is also evidence that public reporting makes physicians at tertiary centers ambivalent about performing at the “cutting edge.”  Many feel that some heroic care offered at academic medical centers is wasteful and seems cruel to dying patients and their families.  However, the “frontier” of medical treatment really does move based on this “cowboy” medicine.  When I was in medical school, treatment of premature newborns under 2 pounds seemed futile; now, such babies are routinely saved, and many go on to lives that are not even marred by severe disability.  Great essay on this by Tom Lee and others "Is Zero The Ideal Death Rate?"


Since public reporting of cardiac surgery, the mortality and morbidity of that surgery has plummeted.  I’m hopeful that the cardiologists will get behind improved risk adjustment and support public reporting of outcomes from angioplasties.   Perhaps in the end we'll have to just remove the highest risk cases from reporting - rather than pinning our hopes on risk adjustment.