Q + A with Tomorrow's Luncheon Guest, Ashish Jha

Ashish Jha sat down with Berkman Center intern Yvette Wohn for a Q + A as a primer to his luncheon talk tomorrow on "Public Report Cards for Doctors and Hospitals: A Cure for the Ailing Healthcare System?"

Q. What is the effect of having the "public report card" evaluation system available online?

We know that physicians and hospitals are paying attention.  Some have responded by making major improvements in the quality of care they provide.  Others have responded by shunning high risk patients to improve their scores.

Q. Is it possible (or fair) to have a standard means of evaluation?

It is possible and even fair.  Over the past 20 years, we have developed a series of measures that are objective, grounded in science, and generally good measures of the kinds of care that physicians and hospitals provide.

Q. Taking into consideration the fact that physicians could deduce which patients are giving them negative feedback, could patients be intimidated not to reveal information that could put them on bad terms with their doctor/hospital?

This is a good question.  There has been a lot of effort, at least in the major programs, to ensure that data are presented in a way that it is extremely difficult, if not impossible, for physicians to deduce who provided negative feedback.  It is always possible that patients may not be aware of this and therefore, internally censor themselves.

Q. Can the HealthGrades system be stressful for those involved with higher-risk diseases?

HealthGrades and systems like this can be stressful for doctors and hospitals that care for high risk patients.  This is why it is so important that we do a good job of risk-adjustment -- so that we don't penalize providers who care for the sickest patients.

Q. In what other ways has the Internet changed how patients give feedback to their healthcare facilities? (or change how information regarding healthcare is publicized?)

The internet has been a very powerful force for change in healthcare, and its transformative potential has barely been tapped.  Arming patients with better information is a very good thing, although at times, given the vast amounts of information out there, patients often can feel lost or overwhelmed.

One way that the internet has not, at least not yet, been very influential, is as a mechanism to provide good feedback by patients.  As this becomes more commonplace, healthcare will become far more responsive to patients' needs.