Patients weigh in on Mass. doctors

Massachusetts residents think their doctors are good communicators, who listen carefully and give clear instructions, according to the first statewide survey on patients' experiences with their care. But patients do not rate their interactions with physicians and their staffs as highly in other areas, including seeing them promptly when they arrive for appointments and knowing their medical history.

Although 73 percent of patients said they would ''definitely" recommend their doctor to others -- and 83 percent of parents said they would definitely recommend their child's pediatrician -- the survey indicates significant variation in how patients say they're treated when they visit or call their primary-care doctor. In the highest-performing practices, for example, 80 percent of patients said that when they called with a medical question they always got an answer the same day. But in the lowest-performing groups, just 30 percent of patients said they always got a prompt response.

The public can view performance results for more than 400 multi-physician practices -- though not for individual doctors -- at www.mhqp.org, the website for Massachusetts Health Quality Partners, which conducted the survey. The organization, a coalition that includes health insurers, hospitals, and doctors, is the first in the country to rate doctors' practices based on patients' experiences. A California organization publishes a similar survey, but it rates large medical groups, not individual offices.

Until now, the growing number of public report cards rating doctors and hospitals have focused on clinical care, from how well doctors control their patients' diabetes to how often patients die after heart bypass surgery at specific hospitals. But data on patients' experiences represent a coming wave of public reporting on provider performance. Similar to customer service information commonly collected by businesses, the new data have the potential to interest more consumers, because the information applies to all patients no matter their condition -- even excellent health -- and shines a light on the small and not-so-small annoyances patients can face when they try to get even simple medical care. The federal Medicare program plans to post data on patients' experiences in hospitals by next year, and another national organization is working on a similar survey about doctors.

In the past, ''I have heard doctors say, 'What are patients complaining about? At least they have an appointment,' " said James Conway of the Institute for Healthcare Improvement, a nonprofit organization in Cambridge that advises providers on improving quality. ''But there is no question that this is changing. Doctors have gotten the message that consumers have higher expectations. Publishing this data is a pretty gutsy move."

By posting data on patients' experiences, Health Quality Partners hopes to help consumers decide where to seek medical care, and to push doctors to improve. The organization also rates physician groups on a variety of clinical measures, previously posted on its website. Health insurers and the state, which has its own website comparing hospital mortality and surgeons' experience for various procedures, also hope that the public reporting will drive improvements in quality, particularly as the cost of medical care soars.

Barbra Rabson, executive director of Health Quality Partners, said patients' experiences are crucial, not just because people don't like to wait, but because studies show that patients who feel good about their interactions at the doctor's office are more likely to follow medical advice and return for follow-up visits. But the emphasis on patients' experiences is so new that doctors have not spent as much time improving access, punctuality, and coordination of care as they have clinical care, she said.

It is unclear how Massachusetts doctors compare with their peers across the country, because there are no national data on patients' experiences with their doctors.

To do the survey, which was paid for by the state's five largest health insurers, Health Quality Partners hired an outside company to mail a 50-question survey to 150,000 patients and parents of young patients who are the health plans' members between July and September 2005. The group received more than 50,000 responses, covering more than 3,500 primary care physicians. The group rated practices with three or more doctors.

It began sharing practice-specific data with doctors in November; physicians can purchase individual data on themselves. The group made the performance ratings available to the public today, giving practices one to four stars on each of eight general areas, such as communication, scheduling appointments, how well doctors know their patients, how well they give preventive care and advice, and how well they coordinate care. Consumers can then look at how a practice's patients answered each of 28 questions within those categories. The group also plans to post another measure soon that was not ready today: what percentage of patients would recommend their doctor in the practice to family and friends. Health Quality Partners provided the Globe with statewide results on this and other measures.

Physicians have mixed reactions to the data's release, although most see it as inevitable and agree that patients have a right to see the results. The Massachusetts Medical Society, the state doctors' organization, endorsed the project.

Harvard Vanguard Medical Associates, which scored extremely high on previously-released clinical measures, did well on access and communication. But a number of its practice sites got just two stars, meaning they are in the bottom half of practices, on how well patients feel their doctors know them and their medical history. Dr. Richard Marshall, chief medical officer, said this can be a hazard in a large practice that is open long hours; patients sometimes come in when their doctors are not working and see other physicians or nurses. The group is now figuring out ways to combat this problem.

''No one likes getting data showing that only half of patients feel you have enough medical information to diagnose their problem," said Marshall, who is a Health Quality Partners board member. ''But it's not something [doctors] have systematically addressed yet."

Dr. Richard Parker, medical director of the Beth Israel Deaconess Physician Organization, said he gave doctors in his group the data a month ago and everyone agreed to develop action plans for improvement in certain areas. But he said physicians sometimes have less control over patients' experiences in their offices than they do over the patients' clinical care.

''It's usually not just the doctor; it's the whole office," he said. ''This is about running a business. In the real world, if you can control some of this and you have resources, you will. But if you work in an office owned by a hospital, it may not be up to the doctor to fix things."

Dr. Martin Solomon, a doctor with a Brigham and Women's Hospital practice in Brookline, was upset about how his group performed, because he did not think Health Quality Partners sampled enough patients to draw meaningful conclusions. The group used responses from between 43 and 84 patients of the practice for most questions; the doctors have a panel of 18,000 patients, Solomon said. The group got two stars on communication, coordination of care, and how well doctors know patients.

Rabson said Health Quality Partners threw out data if they did not meet a high standard of reliability, and did not rate groups when data were insufficient on a particular question or group of questions.

But rather than ''beat up on doctors," Solomon said, patients should discuss problems with their physician.

''Delivering primary care today is very hard -- the pressures on us are huge. The waits are because of the overwhelming volume of patients who need to be seen urgently."