Topol on the Problem With 'Scorecard' Medicine


July 16, 2014

Dear Medscape Readers,

This month I'd like to delve into the problem of scorecards in medicine, now that Consumer "Medical" Reports has really entered the arena. In its August issue, the magazine published ratings of heart hospitals throughout the United States for open heart surgery outcomes, using the Society for Thoracic Surgery (STS) database.


Top Hospitals for Heart Surgery in the Northeast as identified by Consumer Reports.

Just a few months earlier, in its May issue, the magazine published an article ironically titled "Survive Your Hospital Stay," rating nearly 3000 hospitals for safety on a scale of 1 to 100. No hospital in that report scored even an 80.

I don't have to mention that this is what the public is reading. Consumer Reports has nearly 8 million subscribers and is considered a go-to resource for unbiased information.

Twenty years ago I coauthored a report[1] about the likely potential for such rating entities as Consumer Reports to start providing such data, especially because New York State and Pennsylvania had initiated open heart surgery scorecards by that point. It took a while, but it has finally arrived in full force. And, of course, it's not just Consumer Reports; plenty of other venues for physician and hospital ratings are out there and are gathering momentum, from Angie's List to Yelp to Better Doctor.

However, there are major stumbling blocks to these data being truly informative and useful for consumers. Individual ratings are plagued by the wrong metrics. We have seen studies of patient satisfaction notably affected by whether the patient received the prescription sought (such as pain medications and antibiotics), or by such factors as parking availability and friendliness of the office staff. More importantly, data are limited in publications like Consumer Reports when it comes to what procedures and diagnoses can be objectively rated.


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