4 paradoxes of healthcare ratings, rankings and data on the web

Few consumers trust the internet for health information and few are aware they can exercise choice in picking a surgeon or hospital, according to results from CMS-commissioned surveys and focus groups.

After he filed a Freedom of Information Act request for CMS-commissioned contractor reports, Jackson Williams obtained a 208-page PDF from CMS that contains seven surveys, focus group results and other reports commissioned and used to guide the development of HHS transparency tools.

Mr. Jackson, director of government affairs at Dialysis Patient Citizens in Washington, D.C., combed through the findings and identified four paradoxes that emerged from two reports that specifically gauged consumers' attitudes toward healthcare data and transparency. He shared his findings in a blog post for Health Affairs

1. Physicians, not websites, are the most trusted sources of healthcare information. One CMS-commissioned survey found 77 percent of consumers cited a physician's recommendation or referral as the most influential when choosing a hospital and 73 percent see physician input as the best guide when selecting a physician, whereas 61 percent of consumers cited quality ratings as an influence over their healthcare decisions. Another survey was even less promising for the internet: 6 percent of consumers said they consider it a "most trusted" source for finding a physician whereas 58 percent put great trust in guidance from physicians or nurses, 47 percent in friends or family and 14 percent in their insurer or drug plans.

2. Consumers have mixed reactions about the government's involvement in healthcare quality ratings. One CMS-commissioned focus group identified "mixed reactions" and doubts raised by participants over the government's involvement in quality ratings. Although participants saw .gov websites as more authoritative than .orgs, several participants expressed skepticism over trusting the government to compile information.

3. Quality ratings don't answer consumers' most pressing question. In one survey, nearly half of respondents said information about treatment effectiveness is either the most important or second most important domain of healthcare quality, yet information about treatment efficacy is not provided on CMS' Compare websites.

4. Few consumers feel empowered to act upon ratings. One contractor noted its focus group participants were largely unaware that they had options or could exercise choice in picking a surgeon or hospital. Many participants believed these decisions were left up to referring physicians, insurance networks and proximity to their residence. Mr. Williams noted that "unfettered freedom of choice is a foundation of fee-for-service Medicare, making the fact that none of the participants had ever heard of the CMS Compare tools prior to July 2015 somewhat ironic."

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