California needs more medical residency options

Our health system is broken ! Another situation that defies common sense in a state that is underserved.

Read the story about a medical student who wants to practice primary care and psychiatry, who cannot find a suitable residency in California.

By Trevor Cline

California and its public education system is the only home I’ve ever known. I’m a proud alumnus of UC Berkeley and soon-to-be alumnus of the UC Davis School of Medicine.

I understand my state’s needs and want more than anything to serve urban California communities as a dually trained internist and psychiatrist. In order to realize my dream, I need to match into a residency program, otherwise known as a graduate medical education program.

There is currently only one dual-training residency program in our entire state. Because of that, there is a very real possibility I will have to leave California, the only place I want to live and work, to continue my medical training.

This lack of graduate medical education training positions, especially in primary-care specialties like the one I wish to match into, is problematic in many ways.

First, it deprives our state of its physician workforce, as doctors are more likely to permanently live and work within 80 miles of where they receive GME training. It also perpetuates an existing health care access crisis and physician shortage that exists throughout our state.

California ranks 32nd in access to doctors compared to our neighboring states. Nearly 40 percent of our state’s counties fall below what is considered a minimum physician-to-population ratio to allow those seeking medical care to be able to do so in a timely manner.

To compound this issue, most GME programs are funded by federal Medicare dollars, which haven’t increased in nearly 20 years to keep pace with an increasing population and demand for doctors.

The lack of coordination of health care at the state level and federal level defies understanding when Obamacare increased the patient load abruptly.  Why was an increase in graduate medical funding included ?

Additionally, it’s projected that California needs 8,423 new primary-care doctors by 2030 to meet our population’s need for care services, and we don’t have nearly enough graduate medical education programs to meet that need.

To help ensure that California patients can see a doctor promptly when they need one, our Legislature passed a budget in 2016 that committed to investing $100 million over three years ($33 million each year) to fund the Song-Brown Program, an existing grant program housed within the Office of Statewide Health Planning and Development that supports primary-care residency programs in medically underserved areas.

However, Gov. Jerry Brown’s current budget proposal eliminates $33.4 million in health care workforce funding and redirects $50 million in tobacco tax revenues (Proposition 56) that was intended to go to GME programs.

It’s disappointing that Gov. Brown dropped his commitment to open more GME programs to keep more highly qualified California medical students in our state.

Anyone concerned with the future of our state’s health should contact their state representatives and Brown’s office. Tell them to stop raiding tobacco tax revenues and invest those funds toward the Song-Brown program and other means of expanding GME programs in California. The future of my profession and the health of our state depend on it.

— Trevor Cline is a student at the UC Davis School of Medicine. He is a dedicated health policy advocate and a medical student leader in the California Medical Association Medical Student Section.

California needs more medical residency options

Poll: 2 in 5 Americans lose sleep over health care costs

Financial insomnia is at its highest level since the Great Recession

Has Obamacare reduced medical bankruptcy?  It may still be too early to determine this. Although medical providers, hospitals, and some physicians report delinquency to credit bureaus, it is up to the collection agency to take further legal actions.  These include obtaining a legal judgment, followed by garnishment of wages, or liens, seizure of bank accounts and other avenues to paralyze a family's finances and emotional health.

Americans are losing sleep over the cost of health care more than other money worries, according to a new national poll by CreditCards.com.  

Key poll findings
Here’s what our poll revealed about money worries that keep consumers up at night:

• Health care tops all worries. Of the five times CreditCards.com has done this money worries poll since 2007, this is the first time health care has been the greatest producer of insomnia.
• Saving for retirement still worrisome: Thirty-seven percent said they lie awake at night worrying about saving for retirement, down from 39 percent in 2016. Nearly half of Gen-Xers said they occasionally lose sleep over retirement savings.
• Student loans robs shut-eye. Many more Americans are losing sleep over their ability to pay educational expenses – from 30 percent in 2016 to 34 percent this year. Younger millennials (ages 18-26) are more sleep deprived over student loans than any other group.
• Mortgage and rent woes stay constant: Worry over making the monthly mortgage or rent payment keeps about 1 in 4 Americans up at night, about the same percentage as every poll since 2009.
• Credit card debt? We mostly sleep through it. Paying off credit card debt (22 percent) keeps people up at night the least of any money worry. It has remained a relatively small concern since the Great Recession despite ballooning card balances and rising interest rates.
• Spending less is key to a good night’s sleep. For this year’s survey, we asked a new question: What are you doing about your worries? Of those losing sleep, nearly 2 in 3 (64 percent) said they reduced their expenses to improve their financial situation in the past 12 months.

The scientific poll of 1,000 consumers was conducted April 6-9 via landline and cellphone. See survey methodology.

                    

Retirement savings and other worriesFor 37 percent of consumers, thinking about saving for retirement prepares you for sleep about as well as an espresso shot and a bucket of cold water in your face. But that number is 2 percent lower than it was in 2016, and this is the first time in our survey’s history that saving for retirement isn’t the biggest financial stressor.

However, people are growing increasingly concerned about paying off student loans. Thirty-four percent said they lose sleep over paying their educational expenses (or someone else’s), up from 30 percent in 2016 and 27 percent in 2009. It’s no surprise given the swelling debt load facing today’s college students and graduates. Outstanding student loan balances reached $1.4 trillion in December, according to the Federal Reserve.

Here are some of the surprises from the poll:

• Health care tops all worries. Of the five times CreditCards.com has done this money worries poll since 2007, this is the first time health care has been the greatest producer of insomnia.
• Credit card debt? We mostly sleep through it. Paying off credit card debt (22 percent) keeps people up at night the least of any money worry. It has remained a relatively small concern since the Great Recession despite ballooning card balances and rising interest rates.

Illness is rarely a choice, and no one elects to be hospitalized (except for elective surgery). This fact should motivate consumers to practice health and wellness which has been proven to reduce chronic illness.  This topic goes beyond this article.

Most consumers deal with this situation by spending less. Some key measures may include;

Do not buy the house you can afford (typical mortgage companies will only finance up to 30 % of income...buy less home.

Transportation: Walk more, or bicycle to work. Consider living near where you work and shop. Do you really need that Tesla ? Mercedes? BMW, Lexus, or SUV?  Other options are to not own an automobile. Uber it ! Rent a car for longer trips.   This . totally eliminates expenses for maintenance,  fuel, etc.  

College: How about a highly rated state university (although some of those are getting pricey)

Vacations:  Do you really have to travel to Bora Bora, or the Galapagos ?

Food: Eating out has become insanely expensive (and probably unhealthy) . Become a vegetarian. Meat and fish as a source of protein has become prohibitive for many. There are vegetable source for a high protein intake.

Consult with a health insurance expert. Consider alternative sources . such as direct payment primary care with a moderate deductible for a supplement for high expense plan. This has become more difficult with Obamacare, since the law requires all insurance companies to cover many things you may not want . (ie, Ob/Gyn, Pediatric, etc)

Maggie Baker, psychologist, financial therapist and author of the book “Crazy About Money: How Emotions Confuse our Money Choices and What to Do About It,” said the rancorous tone of the health care debate likely heightened consumers’ worries. The amount of conflict we’ve been subjected to and the nasty disagreement has made people extremely anxious,” Baker said. “If we were in a calmer political situation in this country, I think people would be worried about health care, but the level of anxiety wouldn’t be quite as high.”

In retirement I have become a spendthrift. I am one of you who could not save for retirement due to medical costs, premature disability due to cardiac disease a son with cystic fibrosis, and severe cuts in reimbursements for physicians.  

I have no shame and neither should any of you who find yourself backed into a corner. For many it is a no-win situation. 

But even if we were all at ease with our health care system, the fear of a costly medical emergency would persist for many consumers.

“When you get sick you are very vulnerable, and you’re not thinking about how you’re going to pay these bills,” Baker said. “Then you have a $500,000 hospital bill and it’s one of the worst negative surprises you can ever get. Emotionally, it wreaks havoc on the person who’s sick.” 

Poll: 2 in 5 Americans lose sleep over health care costs

Poll: 2 in 5 Americans lose sleep over health care costs

Mindfulness, meditation unlikely to cure back pain, study says

A recent study using mindfulness and/or meditation finds it is ineffective in reducing back pain in the long run.

The results were published online April 24 in the Annals of Internal Medicine.

Mindfulness was found to help pain symptoms in the short term, but not in the long-term -- though researchers note it may work better for some than for others.

Although short-term improvements were reported, "no clinical significance" was found in terms of overall pain or disability when mindfulness was compared to standard treatment, said study lead author Dennis Anheyer. Anheyer is a psychology research fellow in the faculty of medicine at the University of Duisburg-Essen in Germany.

Because no sure-fire treatment of back pain exists, many patients try complementary therapies such as mindfulness.

Mindfulness programs, which are growing in popularity in the West, derive from the Buddhist spiritual tradition and are used to treat pain. They include sitting meditation; walking meditation; hatha yoga and body scan along with focusing attention sequentially on different parts of the body

Some patients were offered standard back pain treatment, such as physical therapy and exercise routines that aim to strengthen the back and abdominal muscles; prescription and over-the-counter pain medications; ice packs and heat packs; and spinal manipulation and/or massage (chiropractic care). In some cases, surgery is recommended for chronic back pain.The seven studies that were reviewed involved close to 900 patients who had lower back pain for at least three months. Six of the studies were conducted in the United States; the seventh in Iran.

Caveat:  Pain is a subjective symptom, rated on the patient's perception on a scale of 1-10, with 1 being barely noticeable up to 10... the worst pain and unmanageable causing disruption in activities.

Mindfulness, meditation unlikely to cure back pain, study says - UPI.com

Ask your Physician How he is feeling?

A new public health problem has reared it's head. A study recently revealed that 40% of physicians describe themselves as "burned out".

The government insurance programs, health insurers do not care. Their goal is to extract the most from health providers for the least cost. Change is constant and never ending. A literal explosion of programs, MACRA, MIPS, SGR, ACO, and APMs, using HEDIS and STAR ratings to determine if your physician will be penalized for non-compliance.

Some physicians are now actively aware of the burnout issues, and have formed pro-active groups to reduce physician burnout.

Despite reduced reimbursements to physicians health insurance companies continue to make a profit. If their profits decrease, they eliminate programs that are not profitable.

Many physicians will not accept medicare or any insurance plan preferring to develop their own primary care direct payment business model.

Physician leaders’ role in preventing burnout

DIANE W. SHANNON, MD, MPH | PHYSICIAN | APRIL 20, 2017

A few weeks ago, I had the opportunity to interview a faculty physician at a large academic medical center. We spoke about burnout in students and faculty in general terms. He was aware of the problem yet did not seem affected himself.

Hallmark Signs and Symptoms of Burnout

I asked him how he managed to avoid burnout. He talked about remembering his purpose in entering medicine — that the profession is a calling, not just the daily tasks involved — by re-reading thank you cards from patients, residents, and students. He talked about taking time to chat with the staff in the clinics where he works, getting to know the schedulers by name, for example, to create connection in a world where he sees fewer and fewer opportunities to connect than in the past. Then he mentioned his “boss,” the chair of the department, a practicing internist herself.

He told me that her leadership helped him in small ways and large to avoid burnout. He mentioned her habit of asking, “How are you?” and meaning, “How are you doing as a person?” He said he had the sense that she cared about his well-being as well as the advancement of his career. His mention of his supervisor as a source of “burnout protection” caught my attention. The physicians I’ve interviewed rarely speak about their leader’s role in preventing burnout.

Although I haven’t heard physicians point to the importance of leadership, research corroborates this faculty member’s observation. The Mayo Clinic surveys its employees annually about the degree to which certain leadership behaviors are displayed by their immediate supervisors: appreciation, interest in the ideas and careers of those they supervise, transparent communication, and inclusiveness. Their data show significantly lower levels of burnout among physicians whose supervisors achieve higher scores on these behaviors.

Examples in other industries abound of the impact of leaders’ focusing on the well-being of their workforce. Paul O’Neill, former CEO of the manufacturing giant, Alcoa, steered that company to record high profits within a year by making worker safety the number one priority at every level of the organization.  New United Motor Manufacturing, Inc., or NUMMI, a joint venture between General Motors and Toyota, became one of the most productive automobile plants in the world in the 1980s, with consistently high-quality scores. How? In large part by respecting the inherent knowledge of its frontline employees and making a commitment to their welfare.

Organizational leaders may be hesitant to attempt to address the systemic issues that drive physician burnout, thinking that all interventions are complex and costly. Adopting new leadership behaviors is neither — and has proven beneficial effects on physicians’ well-being.

Burnout directly threatens the health of the clinical workforce, the health care organization as a whole, and the ultimate client, the patient. Isn’t it time for leaders of hospitals and medical practices to take a self-assessment and consider the role they play in perpetuating an unsustainable workplace — and their power to build something better? Isn’t it time for leaders to take the longer view and prioritize meaningful systemic improvement — guided by the input of frontline clinicians — to really address this problem?

Given the increasing prevalence of burnout among physicians and the evidence of its wide-ranging negative effects, the time is most definitely now.

Diane W. Shannon is an internal medicine physician who blogs at Shannon Healthcare Communications.

Reducing Pain through Virtual Reality - The Medical Futurist Newsletter Special Edition

Pain management is a challenge at times. Despite many advances in pharmacology there are pain syndromes that are difficult to manage.

For one, pain is subjective, although at extremes it can be measured by changes in vital signs, heart rate, respiratory rate and involuntary reflexes.

In some cases VR has relieved pain when other medications have not.

attribution: The Medical Futurist Newsletter

Brennan M. Spiegel, MD and his research team at the Cedars-Sinai Medical Center in Los Angeles have already treated more than 300 patients with virtual reality (VR) therapy in a pilot project. These individuals with chronic pain were able to immerse into a VR experience for 20 minutes, and forget about their pain through travelling to Iceland or swimming in the ocean. 

Spiegel: “Our experience has shown that when VR works, it really works. But we’ve also found that not everyone is willing yet to try it out, particularly older patients. In our first study, published in JMIR Mental Health, we found that the average age of patients willing to try VR was 49.7 years old, whereas those unwilling to try it were 60.2 years old on average. This is consistent with the known “digital divide” between generations with regard to comfort and familiarity using digital technologies”.

Do you think VR has any side effects? Or that people could become addicted to it?

Spiegel: “We don’t have much information on this yet, at least as it pertains to therapeutic VR. Compared to something like opioids, which have caused a worldwide dependency epidemic of catastrophic proportions, a non-pharmacological pain remedy like VR is highly desirable and not meaningfully addictive in the same manner. But we should not brush aside concerns that VR has potential to be addictive. That said, in our experience to date, we have not seen patients getting obsessed with VR”.

I read that VR reduced pain was 24 per cent in hospitalized patients. That's a very promising result! What are your personal experiences in this regard?

Spiegel: “After practicing medicine for 19 years, I cannot think of any other treatment I’ve used (short of life-saving maneuvers) with a greater immediate impact on patients than VR. In one case, I treated a patient with 8 out of 10 abdominal pain of unclear origin. Narcotics didn’t work and she was receiving an intravenous drip with ketamine – a powerful analgesic that forces patients into a trance-like state. That didn’t work well, either. But within 10 minutes of using VR she reported “zero pain.” She literally said: “I’m ready to go home, as long as I can bring this thing with me.” She was discharged the next day after nearly a week in the hospital”.

In your view, could VR be included soon in everyday hospital practice?

Spiegel: “Using VR in clinical practice turns a lot of heads. Wherever we travel in the hospital with VR goggles, we receive questions from doctors, nurses, and other hospital staff intrigued by the concept of using VR for patient care. It’s hard to leave a unit without allowing curious doctors and nurses to try the headsets. Time and evidence will tell if this excitement should be sustained. We think it will”.

I believe VR will be effective at home as well.

Reducing Pain through Virtual Reality - The Medical Futurist Newsletter Special Edition

Cigna to implement prior authorization policy for opioid prescriptions

Use of prescribed opioid down close to 12 percent over 12 months 

among Cigna customers.

Starting July 1, Cigna will require prior authorization for physicians prescribing a long-acting opioid that is not being used as part of treatment for cancer or sickle cell disease, or for hospice care, the insurer said.

Also, most new prescriptions for a short-acting opioid will be subject to quantity limits, Cigna said.

In releasing its new safety measures, Cigna is following Centers for Disease Control and Prevention guidelines issued last year that recommend non-opioid therapy as the preferable treatment for chronic pain outside of cancer treatment, palliative and end-of-life care.

Nearly 62,000 doctors within 158 medical groups that are part of  Cigna collaborative care agreements have signed a pledge to reduce opioid prescribing and to treat opioid use disorder as a chronic condition. 

Cigna is working with doctors and providers by analyzing integrated claims data across pharmacy and medical benefits to detect opioid use patterns that suggest possible misuse by individuals.

The insurer alerts doctors when their opioid prescribing patterns are not consistent with CDC guidelines.

It established a database of opioid quality improvement initiatives for physicians to help them determine the next steps for improving patient care, including referrals into chronic pain management or substance use disorder treatment programs.

This may be a step in the right direction. The reduction of 13% in the use of opioids in Cigna's population is significant, but this is still in the short-term.

Alternative medication therapy as well as physical therapy, electrostimulation, meditation are all available.  Usually a patient will select one and if they do not have relief, physicians will prescribe other therapeutic methods.  The pathway for a patient can be circuitous and stressful.  Many are referred to pain specialists, placing a further burden on them. The use of the other medications are not without serious complications, somnolence, decreased cognition, and mood disorders.  Chronic pain exacerbates other mental disorders, increasing anxiety, irritability, sleep disorder, and isolation.

This pilot program, should it continue to demonstrate significant reductions could alter the pattern of opiod prescriptions.

Poppy seeds, the source for opium

Opiod dependence is a serious event for a patient and their families with multiple mental changes, and physical complication.

Cigna authorization personnel will be busy.

Cigna to implement prior authorization policy for opioid prescriptions

Comatose and semi-comatose patiients are often aware of their Envionment

WHAT IS FAMILYPLUG ?


Your loved one or friend is lying there in the ICU hooked up to tubes, and ventilators.  They may or many not be able to respond or in a "locked in" state. Neurologists and PCPs are now more aware of this.


Families and friends are often encouraged to treat and speak to 'comatose patients' as if they are fully awake and aware of their environment.


So while you are visiting you do just that, talking to them and encouraging them to 'wake up".  However, what about during non visiting hours or night-time when staff is not available.


The story of FamilyPlug began shortly after the tragic accident of the Formula 1 driver Jules Bianchi in
Japan in 2014 - an accident which left the 25 year-old racer with an extended head injury followed by a
coma and long months of hospitalisation.


A group of developers,  led by an Italian Insead MBA graduate and entrepreneur with the support of a team of French
developers, the company was able to raise important funds from an international panel of angel
investors from Asia and Europe and is about to enter the market expansion phase.


 Recent studies in Rehabilitative Neuro-Science
and Occupational Therapy demonstrate that an active community of
family members and friends around a severely injured patient, has a
concrete beneficial effect on the recovery path. Regular emotional
stimulation is therefore a key element of the treatments currently
available in the most advanced care homes. Unfortunately, the complexity
of maintaining regular contact with a patient in a Comatose or
Post-Comatose state, especially when extended over a long period of
time, generates a distance that the existing remote communication tools
cannot reduce.


WHO IS FAMILYPLUG FOR?


 FamilyPlug targets a potential market of over 20 million users in the US and Europe
currently struggling to maintain contact with a patient in an immobilized or
semi-conscious state. Launched on both iOS and Android at the beginning of
February 2017, this App is suitable for all medical environments, including Intensive
Care Units (ICU).

iTunes Store Get app

Google Play Store

Launch Video



GET INTOUCH

Media Inquiry Media@FamilyPlug.
Healthcare Media Section WebPage: http://familyplug.healthcare/ 
Mattia@FamilyPlug.Healthcare


MEDIA KIT 8

Your physician is the everyday champion

You and your provider have a big investment in your health.  Much of your tax dollars go to scholarships, building state owned medical schools, funding regulatory agencies such as the FDA, HHS, Public Health Services.

Likewise your physician(s), many of whom go into great debt even before earning their first dollar. Their credit rating is now impaired by this investment.  Some cannot get a mortgage, and not because of flagrant spending.  All the banks and loans institutions are concerned with these days is their ability to make the loan payments.  The number of physicians (and other students) who default on their school loans is staggering, and those loans cannot be discharged in a bankruptcy, the same as with tax debt. It's no longer when a city or town decides to fund a young person's medical training.


SUPREEYA SWARUP, DO | PHYSICIAN | APRIL 15, 2017

The average amount of time it takes someone to become a physician is approximately 11 years, and for those pursuing further specialization, one can easily add a couple of years to that. The time certainly adds up by investing years in college, medical school, residency, and fellowship. By the time I will be an independently practicing cardiologist, I would have invested about 16 years into my training. That’s almost half of my lifetime. Every physician has their own reason for pursuing medicine; however, the majority of us go through such an arduous and invigorating training process because ultimately we want to positively impact peoples’ lives.

Our day typically starts at the crack of dawn and at times ends after sunset. There have been days where I have been disconnected from the world, unaware of the outside conditions, and missed important life events and holidays because my priority has been my patients. During my internal medicine training, I can vividly remember countless times where my first meal of the day was when I had returned home from work. I can also recall numerous days where I remained on my feet, worked around the clock, continuously advocated for my patients, and placed their needs above my own.

I have also witnessed these attributes in my peers and mentors, who work equally hard to ensure the best for their patients. Whether it is staying after a long day of work to transmit medication refills to the pharmacy, accounting for all the charting and paperwork, remaining over time to talk to the patient’s loved ones, or coming in the middle of the night to perform emergent procedures, the unrelenting nature of a physician is refreshing, breath-taking, and inspiring.

The path and journey is not a tranquil one. The road is paved with countless sacrifices, tremendous hard work, unwavering commitment, and several failures but also with triumphs. It takes a special individual to embark and complete this journey: someone who is willing to sacrifice their time, youth, money, relationships, and their health. It often is a cold and heartless process.  In the end, we are the ones called upon to impact someone’s life directly. We earn the responsibility of upholding excellent care towards those we encounter every single time. Thus, the next time you visit your physician notice the compassion in their voice, the sacrifices in exchange for their medical wisdom, and exemplification of hard work in their wrinkles. And know that a lot went into the making.

This article is dedicated to all my peers, mentors, and co-physicians who unceasingly work hard to stand on the front line of health, ensuring well-being for every person they encounter, who at times place their patients’ needs above their very own. Here’s to the everyday champion: your physician.

Your physician is the everyday champion

Yelp reviews prove a reliable tool for determining hospital quality, New York State Health Foundation study says

You cannot base the quality of health care based upon one measure.

Yelp does just that, and is highly misleading to the public.

More consumers use those platforms and comment on them, creating a real-time feedback loop, Foundation says.

According to the New York State Health Foundation, 

"As online tools like Yelp become increasingly popular with consumers looking for information about doctors and hospitals, a study sponsored by the New York State Health Foundation showed yelp ratings were a clear and reliable tool for determining hospital quality as defined by potentially preventable readmissions rates."

"The news for hospitals is positive as well -- by pointing people to higher-quality doctors and hospitals, those institutions can attract market share, leading to more lives saved and more costs avoided for patients, taxpayers and employers."

The results are from crowd-sourced surveys conducted by Yelp.

These internet based rating services are highly inaccurate, misleading and contain faulty data.

Data Metrics
The authors stressed that while there's a strong correlation between Yelp reviews and 30-day readmission rates, there's a lesser correlation when it comes to other quality measures, such as mortality, morbidity and patient outcomes, infection rates, never happen episodes, none of which reflect or influence readmission rates.

The news comes as high-deductible health plans are gaining steam, covering nearly one in three Americans in 2016. The spread of these plans means consumers are paying for more and more of their care out of pocket, giving them a reason to seek out high-quality care at the lowest possible cost.

One-on-one assessment.  

I searched on Yelp for hospitals in my region of Southern California. This area includes a major University Medical Center, A UC Medical School, A regional county medical center which has merged with the new UC Riverside School of Medicine.

Here are the surprising results.  There were many small entities rated side by side along with major secondary and tertiary centers.

Typical Scores

Kaiser Permanente Riverside Medical Center 

Parkview Community Hospital

 Riverside Community Hospital

 Arrowhead Regional Medical Center

 Riverside University Health System Medical Center

Loma Linda University Medical Center

The ratings (according to the number of 'gold stars' reveal how incorrectly Yelp has rates the hospitals in my area.  Perhaps things are different in New York State. In New York State the foundation has it's own self-interests and is biased in it's results to influence acceptance of many government programs for measuring quality and cost.

There may be some lag in the accuracy of the data, even measuring this one metric. And the outcome is highly inaccurate, just based upon one data set. Healthcare is complicated, and measuring it even more so.

The public must become more literate in understanding measures of health care, who is reporting it, and if the data is truly accurate or self serving to the reporting entity.

Much more accurate data can be found at the Medicare Web Site

Medicare provides a consumer experience rating based upon patient surveys as well as metrics established to improve patient outcomes.

Other more reputable rating sites are available. Beware of some of them.

The highest rated doctors may not provide the best care

KEVIN PHO, MD | KEVIN'S TAKE | NOVEMBER 8, 2014

The public can rate and review most things today: books, hotels, and restaurants, to name a few.  Even doctors.  There are more options than ever where patients can rate their doctors online, and hospitals also routinely survey patients about how satisfied they are with their physicians. But while you’re pretty much assured a great meal at a 5-star restaurant, whether you receive excellent care from a 5-star doctor is less certain.

Doctor ratings generally focus on the patient experience, such as wait times, time spent with the doctor, and physician courtesy.  Those are obviously important issues, but they paint an incomplete picture.  Doctors with stellar interpersonal skills may not be the best at controlling patients’ blood pressures or managing their diabetes.  High ratings may identify surgeons with great bedside manner, but mask high surgical infection rates.

The quest for ratings perfection influences medical decision making, as patient satisfaction increasingly affects doctors’ salaries.  According to the management consulting firm Hay Group, more than two-thirds of physician pay incentives are based on patient satisfaction scores.  And Medicare withholds as much as $850 million in payments to hospitals who fail to meet various quality metrics, with patient satisfaction being a significant component.

But doing what’s best for patients won’t necessarily make them happy.  Denying antibiotics for viral infections or saying no to routine MRIs for patients with back pain are both sound medical decisions, but can anger patients; some vent their frustration by poorly rating their doctors. It’s no wonder that many physicians acquiesce to patient requests. In a survey by Emergency Physicians Monthly, 59% of emergency physicians said patient satisfaction surveys increased the amount of tests they ordered.  In another survey by the South Carolina Medical Association, almost half of physicians said that pressure to improve patient satisfaction led them to inappropriately prescribe antibiotics or narcotics.  In fact, Senators Dianne Feinstein (D-California) and Charles Grassley (R-Iowa) wrote a letter to Marilyn Tavenner, administrator of the Centers for Medicaid & Medicare Services, saying that “there is growing anecdotal evidence that these [patient satisfaction] surveys may be having the unintended effect of encouraging practitioners to prescribe opioid pain relievers (OPRs) unnecessarily and improperly, which can ultimately harm patients and further contribute to the United States’ prescription OPR epidemic.”

These extra tests and treatments are expensive and can hurt patients.  A landmark study from JAMA Internal Medicine analyzed over 50,000 patient satisfaction surveys, and found that patients who were more satisfied with their doctors had higher health care costs, were hospitalized more frequently, and had higher death rates compared to less satisfied patients. That makes sense: Patients who receive more drugs and tests are exposed to their harmful side effects and complications.

Now, I’m not saying physicians shouldn’t be graded by patients. Subjective physician evaluations are valuable, but not by themselves. They need to be complemented with objective measures of medical care, like a surgeon’s operative complication rate, for instance. Until physician ratings evolve into a more holistic representation of doctors, they must not be financially tied to how physicians are paid.

And to patients: Don’t automatically choose doctors with the highest online ratings or perfect patient satisfaction scores, because they may be the ones who reflexively prescribe antibiotics or narcotic drugs to inflate their grade.  It’s conceivable that those who have mixed reviews may actually provide better care.  Because they could be the physicians who make the effort and take the time to occasionally say no to patients.

Yelp reviews prove a reliable tool for determining hospital quality, New York State Health Foundation study says