I wanted to take a break from my metatarsus adductus series and talk about something that has been coming up more and more with my colleagues both locally and nationwide. This topic has been on my mind for some time but Dr. DeHeer’s recent Medicaid blog (see http://bit.ly/fYIhaR  ) really brought this to the front of my mind.
All of us are concerned about how our patients perceive us as professionals as well as how we are perceived by the public and what we can do to boost that perception. One of the things that keeps coming up in today’s ever evolving healthcare system is how to measure outcomes and how this can affect our position as providers with certain insurance companies.
So how are you perceived out there? How do you measure that? I would like to think that our increasing patient base and a steady stream of referrals from good sources are good ways to establish your success as a practitioner and affect public perception. I would think this combination tends to be a good litmus test.
Not all insurance companies agree. Many of the larger, private insurance companies do not really look at that at all. They mostly look at two things: your credentials and your utilization. Some insurance companies will remove you from participation if are no longer able to achieve board certification. To them, it does not matter how good you are or how long you have been in practice. It does not matter how happy your patient population and referral sources are with you. To some insurance companies, it does not matter whether you have ever been involved in a malpractice suit.
I always wonder exactly who is responsible for initiating such a clause within the system. Is it for patient protection? Is it for self preservation? Other insurances will try to remove participating providers if they use costly modalities that a desk jockey (a doctor who doesn’t practice medicine anymore) does not think should be used so much. The insurance company pays this desk jockey to ensure proper utilization. How is that possible if he does not practice?
One of the frustrations I have in practice is the Internet. No, really. The World Wide Web provides the layman with so many options that it is frightening. Within several minutes, patients can find out who I am, whether I have ever been sued, the status of my license, whether it has even been revoked or if I have ever had any sanctions against me.
This is not much of a concern for me as I have nothing to hide but it is a little overwhelming. I have had patients outright tell me they looked me up and are “keeping an eye on” me to make sure I do not screw up. Patients are very quick to threaten lawsuits and medical board sanctions at the slightest hint that they are not getting what they think is right or they deserve. This is “armchair medicine.”
The other factor is the websites that let people review physicians. Whether you realize it or not, you have very little input into what someone writes about you on the Web. There are even sites now that have you rated beside your local colleagues. Everyone wants a five-star review, right? Are you going to spend the money on attorneys over a slanderous review? You can but many of these sites are protected under the Constitution and are not deemed responsible for what they allow to be posted as long as it does not violate the terms and conditions of the site. They just posted it but the posters are protected under the website’s terms of service, and their identity is hidden. It is a tough situation.
So is it even possible to measure outcomes given all these factors? I would very much like the input of my colleagues on this. With our generation of practitioners, we may need to be very conscious of this and possibly even change how we practice medicine because of it. Is this fear justified? Let me know.