Idea of the Week: Physicians Profile
"You ought to be able to choose your own doctor" has become the battle cry of many politicians who hope to ride the current backlash against managed care plans to electoral victory this November. As we have noted previously, this sound-bite approach overshoots legitimate concerns about cost-driven decisions by health plans concerning treatments and access to specialists. It also threatens to unravel managed care's one major accomplishment: breaking the back of health care inflation (and the associate rise in the ranks of the uninsured) by eliminating the money-is-no-object ethic of the old fee-for-service system of health insurance.
Many health care plans, of course (especially the preferred provider organization, or the PPO model), allow some consumer choice of both primary care and speciality physicians. But whether you are talking about choosing physicians under managed care or under the old fee-for-service system, how, exactly, do consumers choose wisely? After all, Marcus Welby, MD, has retired. Do you rely on word of mouth? Advertising (strongly discouraged and limited by the profession)? Convenience? Referrals from other physicians? Trial and error?
The truth is that it is much harder to knowledgeably chose a doctor than a car, a school, a house, or even a health plan. "Freedom of choice" is pretty meaningless without the ability to make an informed choice.
In Massachusetts, you can make a phone call or go onto the Internet and immediately get basic information about any of the 27,000 doctors licensed to practice medicine in the state. Thanks to legislation sponsored by State Sen. Mark Pacheco (D- Taunton), a member of the DLC's State Legislative Advisory Board, the State Medical Board prepares and updates "physicians profiles" that provide:
Are Massachusetts consumers using this information? Since "physician profiles" went up on the Internet in May 1997, the web site has averaged 1400 "hits" per day, along with 125 phone calls a day to the state medical board. An estimated 50,000 requests for profiles were received by the state medical board's hotline (800/377-0550 or 617/727-0773) before the web site information became available. Clearly, these profiles have become an important and routine part of the process of choosing a doctor in Massachusetts.
Most interesting of all, Massachusetts physicians have actively cooperated in the profile initiative. Pacheco's legislation required that physicians have the opportunity to review profiles to check their accuracy before they were posted. Physicians and their representatives have worked with the state medical board in improving the information it provides. A "virtuous cycle" of more sophisticated information, and more intelligent consumer choice, appears to be in play.
Other states are working on similar initiatives, including Florida. It's time for even more states to follow suit with their own physician profiles. No matter how the current debate over managed care and consumer choice plays out, empowerment of consumers with better information on both providers and health plans is essential to ensure that the values of choice and quality pull the health care system in the same positive direction.