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Issue of the Month: Public Disclosure—An Essential Step for Quality Improvement

Data on the clinical performance of primary care physicians are now publicly available at the medical group level in Massachusetts, following the release this month of a report by a coalition of physicians, hospitals, health plans, purchasers, consumers, government agencies, and academics. Formed in 1995, Massachusetts Health Quality Partners (MHQP) gathered information from the state's five largest private health plans on the quality of care provided by 150 medical groups. The coalition then posted this data on its website to encourage consumers to search for high-quality providers and guide physicians looking to improve their performance.

Previously, MHQP has made performance information available at the hospital and health plan level. The new report, "Quality Insights—Healthcare Performance in Massachusetts: Clinical Quality in Primary Care," goes a step further by enabling consumers to evaluate the performance of medical groups across 15 measures of clinical quality developed by the National Committee on Quality Assurance (the Health Plan Employer Data and Information Set, or HEDIS). Consumers can search for quality information by physician name and location.

The MHQP coalition, which has worked to engage physicians in the data release process, recognizes that public disclosure is an essential step in the process of quality improvement. By providing data on physician groups—rather than limiting the release to state performance averages—it's possible to identify variations in care and begin to understand why some groups perform better than others. This year's report, for example, found significant variation in how well physicians care for patients with depression, those with asthma, and teenagers.

Most doctors rely on external sources of data about their quality, according to the Commonwealth Fund National Survey of Physicians and Quality of Care. Though it would be best for physician practices to collect and analyze the measures themselves, the next best option is to have a group such as MHQP develop a valid process that is trusted by the key players involved. MHQP helps physicians understand how well they are taking care of their patients and compare their performance to that of their peers. It's anticipated that this will motivate practices to find out how high-performing groups are achieving good results and help them improve their practice's performance in the next measurement cycle.

The MHQP site enables consumers to see a percentage score for each physician group and compare that with state and national averages. The state's Office of Health and Human Services also provides visitors to their website with access to the MHQP data. In addition, the state recently began to publish information on surgeons and hospitals, consisting of cost data and volumes of procedures for 10 inpatient surgeries by surgeon and hospital. Other states, including Minnesota and California, provide information about the quality of physician groups, yet these remain the minority. This slow adoption of public reporting needs to be addressed for progress to be made in this area.

In March, MHQP will release information from a statewide survey that asked patients about their care experiences at about 500 practice sites. Such information is thought to be important to consumer decision-making: some physician groups have multiple practice sites, and the care patients receive may depend on where they go for treatment. Yet this level of analysis remains difficult for many measures of effective care, such as the HEDIS measures reported by MHQP at the group level, because of the low numbers of patients per physician or practice available to calculate scores. Pooling data from multiple payers, including Medicare and Medicaid, might help solve this issue—and is one reason why collaboration between the private and public sector is so important. The MHQP analysis has succeeded at the physician group level because it was able to pool data from multiple private payers.

This month's Perspective provides the views of two Massachusetts physicians, the chief medical officer and chief executive officer of Partners Community HealthCare, Inc., on the reasons why physicians should care about the work of MHQP and the impact the performance data are having at their organization.

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