Honda, Toyota and Alegent Health

I was in an airport a couple months ago, killing time in a gift shop, when I came across the September 2011 issue of Consumer Reports magazine with a cover story entitled “Protect Your Heart.”  Always on the look-out for grist for my blog I snapped up the issue (at a ridiculous price of $5.99—I can almost get a Grisham paperback for that amount.  But, hey, no price is too high to get through the time between entering the airplane and the moment they announce you can finally turn on your iPad.)  To my surprise I came across a story that not only discussed the quality of cardiovascular programs around the country but went so far as to grade each one.

Naturally I skipped through the “A” states (Alabama, Arizona . . .) and quickly found my way to “N” where I was pleased to see that my own group earned highest marks.  Alegent Health of Omaha, and in particular the heart program at Bergan Mercy Medical Center, was rewarded with three stars for all the work we’ve done in improving patient outcomes and providing quality care.  I immediately shared this with the guy sitting next to me, who was less than impressed and seemed to be more focused on the flight attendant’s safety briefing than on trying to figure out where he should get his next bypass surgery.  I briefly entertained the idea of reminding him that he stands a far greater chance in his lifetime of coming under the heart surgeon’s knife than ever needing to use his seat cushion as a flotation device on a flight from Omaha to Denver, but I just let it go.

I find it kind of funny that Consumer Reports is now in the business of reviewing medical care.  While I’ve never had a subscription to this magazine I’m quite familiar with its layout and purpose.  Their editors buy up a sampling of some type of product (appliances and electrical devices are favorites) and run them through a series of tests in an attempt to find out which particular model is the most reliable, functional, and worth the money.  A typical issue will tell you, for example, which toaster is the best value for your buck and whether a Honda is really more reliable than a Hyundai.  They also take into account feedback from their thousands of loyal subscribers, especially when it comes to big-ticket items like automobiles.

I’ve never had much need for Consumer Reports’ advice, since my method of choosing a new car or appliance mostly comes down to which one looks the coolest or accelerates the fastest (cars, not appliances), but it’s somehow reassuring to me that their unbiased editors agree with my own assessment of my practice’s performance.

Consumer Reports’ foray into health care (other articles in that issue: “How to keep it young,” “Risky tests to avoid,” “Angioplasty: What your doctor might not tell you”) seems to be part of a bigger movement by the lay press to get a handle on the rating of health care, a trend that includes Angie’s List’s recent addition of physicians to their catalog of reviewed professions.  I have previous written on the explosion of doctor-rating web sites and concluded that they leave something to be desired.  This particular issue of Consumer Reports is, however, a bit novel in that it takes a more scientific approach to evaluating the product we provide.  The information they base their rankings on comes from a large database collected by the Society of Thoracic Surgeons and takes into account hospital length of stay, complications, and requirement for readmission and repeat procedures.

Unfortunately, such data doesn’t really exist for other parts of our specialty.  No one tracks how well I implant pacemakers or do heart catheterizations.  There is no database that provides feedback about how well I’ve chosen medications to treat high blood pressure or whether I correctly differentiate between true cardiac chest pain and heartburn.  We track a few things in the clinic and hospital that we call “quality measures,” such as how well we comply with current guidelines for treatment of congestive heart failure and atrial fibrillation, but these parameters just scratch the surface when it comes to the many decisions we make with each patient.

And what about parameters that are most meaningful to patients?  To many people, a one percent difference in heart surgery survival (which, by the way, is often all that separates the good from the great programs) may not mean as much as how well the doctor communicates with the patient and family.  Heart attack victims understand the importance of getting therapy quickly, but probably care more about their ICU nurse’s level of attentiveness than whether I get them into the cath lab within 90 minutes (one of the few parameters that is actually closely tracked and another area where our local doctors and hospitals excel).

Some of this is already done, but to a limited degree.  Alegent Health gathers “customer feedback” by calling a small percentage of my patients to ask about their interaction with me (note to my patients: I’m willing to pay a small bribe if you conveniently forget all my faults when you get that phone call) and actually bases part of my pay on my bedside manner (hence my application this year for food stamps).

Someday I suspect we’ll see magazines like Consumer Reports publishing detailed rankings of doctors that include markers that matter to both patients and medical epidemiologists.  They’ll probably be able to incorporate monetary value in their calculations as well.  Does your doctor stick with generic medications when possible or order the most cost-effective test when the opportunity presents itself? Does your doctor adequately emphasize health maintenance and prevention?  Which clinic provides you the most comprehensive care for the money?

For now, the Consumer Reports’ review of cardiac surgery centers is based on such a limited data set that a critique on the subject would be akin to an automobile review that provides information about engine durability but pays no attention to comfort, ride, accessories, or performance.  Someday that might be different:

Dr. Van De Graaff, Cardiologist, Omaha NE

1 star out of 4
A satisfactory doctor with a fair knowledge base and a reasonable work ethic.  The bedside manner is less that what you might expect in this class of medical professionals, but is serviceable.  Procedural complication rates are a bit higher than average but 5-year mortality among reviewed cases is within acceptable limits.  Knowledge of cardiac physiology is low and writing skills are mostly nonexistent.

Pros:  Has the ability to produce two pages of nonsense every week.

Cons: Poor sartorial insight, weak sense of humor, cold stethoscope.  Never learned how to use seat cushion as a flotation device.