Mass. doctor networks rated high in quality-of-care study

Doctors at Harvard Vanguard Medical Associates came out on top in the state's most ambitious physician report card, ranking highest among major physician networks in seven of 16 measures, from treating depression to screening women for sexually transmitted disease.

Two other physician networks, Partners Community Health Care and Lahey Clinic, were close behind in the ratings.

The report card, based on claims data provided by insurance companies, found that all nine networks that were rated consistently provide care well above the US average, and more often than not, in the top 10 percent. Nonetheless, the authors at Massachusetts Health Quality Partners hope that publishing detailed quality measures on the Internet will pressure physician groups to improve in areas where they lag behind their local peers.

''Our physicians are very competitive, so if they see they are not at the top, that's a big motivator," said Barbra Rabson, executive director of Health Quality Partners, a 10-year-old group composed of doctors, hospitals, insurance plans, and other medical interests.

The report card is unlikely to help individual patients select a primary care doctor, in part because it focuses on the performance of large organizations with hundreds of physicians scattered over multiple locations.

Many measures reflect less on doctors' skill than on how well organized the network is to provide long-term follow-up, such as ensuring that people with diabetes get annual eye exams.

Everyone involved with the project emphasized that the measures provide a partial picture of medicine, omitting assessments of specialists altogether.

In addition, ratings for 160 smaller physicians' groups won't be released until next year.

Still, the report marks the start of a new chapter in the movement toward greater accountability in medicine, culminating years of internal debate among the physician groups being rated. Though medical ratings have proliferated, this is the first rating in Massachusetts generated by the doctors themselves. In fact, the existence of Massachusetts Health Quality Partners reflects the medical profession's recognition that the trend toward rankings will continue, one day likely becoming a factor in how much insurance companies pay for medical care.

Health Quality Partners settled on 16 quantifiable measures developed by the independent National Committee for Quality Assurance, representing five areas of medical care: disease prevention, diabetes, asthma, depression, and heart disease. Researchers then checked how often doctors in each network provided the recommended care, based on claims in 2003 to the five biggest health plans in the state.

Harvard Vanguard Medical Associates, a network of 500 doctors caring for 300,000 patients in Greater Boston, attributed its high ranking to years of top-level efforts to boost disease screening and routine follow-up care, key factors in the report card. Harvard Vanguard's software gives doctors a checklist of important issues to discuss with patients, and the organization routinely notifies patients when they need blood tests or other lab work.

But Dr. Richard Marshall, Harvard Vanguard's chief medical officer, said he saw room for improvement, cautioning that in a country where hundreds of thousands of medical errors hurt patients each year, ''We all ought to be doing better on healthcare quality."

In some areas, little difference was reported between the highest- and lowest-ranked physician group. For instance, Harvard Vanguard had the highest rate of cervical cancer screening (95.9 percent of women were screened over a three-year period), while South Shore-based Primary Care LLC ranked lowest, despite an 86.3 percent screening rate that was still above the national average. In part because the margin between ''best" and ''worst" performers was often so small, many doctors involved in the project objected to an overall ranking of the networks.

As a result, the report, available at www.MHQP.org, does not rank the networks, but instead shows how they performed on each measure, compared with state and national averages.

Those involved in preparing the report agreed that Harvard Vanguard ranked the highest, though, getting the top rating -- three stars -- in nine measures, while Partners Community Health Care and Lahey Clinic were close behind.

Partners, the state's biggest network, with 1,100 primary care doctors at Massachusetts General and Brigham and Women's hospitals, among others, received three-star ratings in seven measures. Lahey, which represents 450 doctors treating 200,000 patients at its Burlington clinic and other offices, also received the three-star rating in seven categories.

The other six networks did not rate as high, but still consistently exceeded the national average. Even Primary Care LLC, whose 175 doctors generally received the lowest ratings, was above the national average in 13 out of 16 measures.

Dr. Marc Edelstein, chief executive of Primary Care, conceded that his network did only ''OK" in the rankings, but he stressed that the competition was intense. ''We're being compared against the most organized groups in the country," said Edelstein, whose network treats more than 250,000 patients. ''Given the fact that the bar is pretty high, we're pleased."

Some observers predicted that the report card is the start of increasingly more detailed measurements of doctors that could one day tell consumers ratings for individual doctors. Tufts Health Plan has been ranking the care physician networks give its members for four years; it has refined the report card to focus on groups of doctors rather than on the larger network they belong to.

''There is increasing call . . . for more patient-friendly data to really help them make intelligent choices about their healthcare," said Dr. John Freedman, who manages Tufts' report card.

Increased scrutiny, in turn, could spur doctors to organize into larger networks that can afford strong support staff and state-of-the-art technology, predicted Dr. Michael Kelleher, medical director for Fallon Clinic, which comprises 240 doctors at nearly 30 locations in Central Massachusetts. ''We've begun to see that coordinated medicine produces very high-quality performance," he said.

Scott Allen can be reached at allen@globe.com.