Topol on the Problem With 'Scorecard' Medicine

| Disclosures | July 16, 2014

While open heart surgery has key, hard outcome data, such as 30-day mortality, few other medical conditions or procedures possess any data as concrete. So most of the data used to generate these ratings is based on soft stuff, which certainly has the potential to be misleading to consumers who are looking for objective guidance.

Ironically, Jonathan Kolstad, the noted Wharton health economist, won the prestigious Arrow Award this past year for showing what really motivates physicians: competing with peers -- not financial incentives. In fact, competing with peers was 4 times more powerful a factor than money, according to a report in the New Yorker.

In April of this year, when the Medicare physician 2012 database was released, a whole new type of scorecarding was made public. Now anyone can look up a physician's billing for Medicare patients, and that includes the number of procedures each physician bills for. A consumer might get the impression that the more procedures, the better the doctor. But we have already seen multiple examples that could indicate just the opposite -- indeed, either exuberant use of procedures or even fraud in some cases.

This remains a big, unsettled issue, a real conundrum. Although ratings could be great for incentivizing physicians to compete with their peers, and could be valuable to consumers who are hungry for useful information that previously was largely unobtainable, there doesn't appear to be a clear path forward. In the meantime, it seems that Consumer Reports ought to provide a caveat to this effect. I'll be interested in your ideas and feedback on this important issue.

Best regards,

Eric J. Topol, MD

Editor-in-Chief, Medscape


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  1. Topol EJ, Califf RM. Scorecard cardiovascular medicine. Its impact and future directions. Ann Intern Med. 1994;120:65-70. Abstract

Authors and Disclosures


Eric J. Topol, MD

Director, Scripps Translational Science Institute; Chief Academic Officer, Scripps Health; Professor of Genomics, The Scripps Research Institute, La Jolla, California; Editor-in-Chief, Medscape

Disclosure: Eric J. Topol, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AltheaDX; AT&T; Biological Dynamics; Cypher Genomics; Dexcom; GenapSys; Gilead Sciences, Inc.; Google; Illumina, Inc.; Portola Pharmaceuticals; Quest Diagnostics; Walgreen Company
Received research grant from: National Institutes of Health; Qualcomm Foundation

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