About the Physician Organization Report
What is the myCareCompare Physician Organization Performance Report?
What is a Physician Organization?
Why are Physician Organizations important to me?
Which Physician Organizations are included in the myCareCompare PO Performance Report?
What do “IPA” and “PLLC” mean in some of the PO names?
How are the Physician Organizations measured?
Are all Physician Organizations in Southeast Michigan included in the Report?
How can I search for a physician in the Report?
What is a Primary Care Physician?
How were these topics selected for measurement?
Does a low score mean that physicians in the PO give poor care?
Why is data not available for University of Michigan Faculty Group Practice for the measure "Controlling Blood Sugar for Patients with Diabetes"?
What are benchmarks?
I need a doctor. How will this Web site help me?
My doctor is not listed. What does that mean?
What should I ask my doctor?
Where can I go for more provider performance information?
What is the myCareCompare Physician Organization Performance Report?
The myCareCompare Physician Organization (PO) Performance Report is the first of its kind in Michigan. The Report includes information about people enrolled in the major Southeast Michigan commercial health plans: Blue Cross and Blue Shield of Michigan’s PPO and HMOs Blue Care Network, and Health Alliance Plan (“HAP”) in the 2009 and 2010 data and those health plans as well as Priority Health in previous years. Most recently updated in the spring of 2012, the Report includes five years of data. (See “Where did the data come from?”)
You can use this Report to:
- Understand how well doctors and hospitals in Southeast Michigan provide some types of care.
- Learn about the differences in the quality of health care. This is important because both good and bad care are being provided in hospitals and doctors’ offices.
- Learn how to form a better partnership with your doctor.
- Help select a doctor for you and your family.
- Become a better-informed health care consumer.
- Learn about things you can do to improve the care you get related to the measures included in the Report.
Doctors also use this Report to see how they compare to other doctors, to learn from each other and to improve the care they give.
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What is a Physician Organization?
Many doctors in southeast Michigan belong to groups called Physician Organizations (POs). Physician Organizations help doctors share information about best practices for treatment, which helps doctors improve the quality of your care. POs also work with their physicians to help keep costs down so that medical care is more affordable. Physician Organizations are made up of doctors in many specialties in offices and clinics throughout Southeast Michigan. Physician Organizations vary widely in the number of physicians and the location of the physician offices included in each PO.
Learn more about the POs included in the Report by clicking on the PO's name; on the profile page showing all of the data for a PO, click the option to "view PO's website" under the PO name.
Why are Physician Organizations important to me?
Doctors in Physician Organizations work together to share best practices to make sure that their patients receive high-quality care. Some POs and their doctors provide excellent care, while others are still improving. Although there are differences in PO performance, physicians are working to continuously improve and provide high quality care. For example, some POs are working with physicians to implement electronic prescribing and patient tracking systems or “registries” that help physicians better manage care; others have added use of a tool to improve care of high blood pressure in their patients with diabetes. (See also “What should I ask my doctor?”)
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Which Physician Organizations are included in the myCareCompare PO Performance Report?
Sixteen Physician Organizations located in the seven county region in southeast Michigan served by the Greater Detroit Area Health Council are included in the Report:
Ask your doctor which PO he/she belongs to and what your doctor and his/her PO are doing to improve quality. Even if your doctor is not in any of the POs included in the Report, it can help you understand how physician quality is measured and what types of things to consider when choosing a physician. It can also help you think about other things you may want to discuss with your doctor. (See “What should I ask my doctor?”) You also may wish to see “Are all Physician Organizations in Southeast Michigan included in the Report?”
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What do “IPA” and “PLLC” mean in some of the PO names?
These terms describe the type of organization. Some of the POs include these terms in their official names used on myCareCompare.
An “IPA” or “Independent Practice Association” is a group of private physician practices, like a Physician Organization. (See “What is a Physician Organization” and “Why are Physician Organizations important to me?”)
“PLLC” stands for “Professional Limited Liability Company” and is a legal term for the type of incorporation.
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How are the Physician Organizations measured?
myCareCompare shows how doctors in Southeast Michigan give care in the following areas:
- Diabetes Care
- Blood Sugar Testing for Adults with Diabetes (data for 2006, 2007, 2008, 2009 and 2010)
- Blood Sugar Control for Adults with Diabetes (2007, 2008, 2009 and 2010 data only)
- LDL Cholesterol Testing for Adults with Diabetes (data for 2006, 2007, 2008, 2009 and 2010)
- LDL Cholesterol Control for Adults with Diabetes (data for 2006, 2007, 2008, 2009 and 2010)
- Cholesterol Medication Use for Adults with Diabetes (2007, 2008 and 2009 data only)
- Heart Disease
- LDL Cholesterol Testing for Adults with Heart Disease (2007, 2008, 2009 and 2010 data only)
- Cholesterol Medication Use for Adults with Heart Disease (2007, 2008, 2009 and 2010 data only)
- LDL Cholesterol Control for Adults with Heart Disease (data for 2010 only)
- Antibiotic Use
- Appropriate Use of Antibiotics for Adults with Bronchitis (2007, 2008, 2009 and 2010 data only)
- Appropriate Use of Antibiotics for Children with Upper Respiratory Infections (data for 2006, 2007, 2008, 2009 and 2010)
- Testing Children with Throat Infections (data for 2006, 2007, 2008 and 2010)
- Cancer Screening
- Breast Cancer Screening (data for 2006, 2007, 2008, 2009 and 2010)
- Cervical Cancer Screening (data for 2006, 2007, 2008, 2009 and 2010)
- Colon Cancer Screening (data for 2006, 2007, 2008, 2009 and 2010)
- Back Care
- Use of Diagnostic Testing for Adults with Low Back Pain (2007, 2008, 2009 and 2010 data only)
- Child and Adolescent Health Care
- Childhood Immunizations (data for 2006, 2007, 2008, 2009 and 2010)
- Well Child Visits for Children 15 Months Old (2007, 2008, 2009 and 2010 data only)
- Well Child Visits for Children 3–6 Years Old (data for 2006, 2007, 2008, 2009 and 2010)
- Adolescent Immunizations (data for 2010 only)
- Asthma Medication Use
- Medication Use by Children and Adolescents with Asthma (Ages 5–11 Years Old) (data for 2006, 2007, 2008, 2009 and 2010)
- Medication Use by Adults and Adolescents with Asthma (Ages 12-50 Years Old) (data for 2006, 2007, 2008 and 2009 and 2010)
- Emergency Room Use
- There are no graphs for these measures; however, click on this tab for important information about ER visits.
- Generic Medication Use
- Use of Generic (Non-Brand) Medications (data for 2006, 2007, 2008, 2009 and 2010)
A definition for each of the ratings is included in the Report and can be accessed by clicking the red "Read More>>" button at the top of each graph.
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Are all Physician Organizations in Southeast Michigan included in the Report?
No. Some POs did not have enough data to be included in the Report. However, even if your doctor is not in any of the POs included in the Report, the Report can help you understand how physician quality is measured, what types of things to consider when choosing a physician, and help you think about things you may want to discuss with your doctor. (See “What should I ask my doctor?”)
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How can I search for a physician in the Report?
Click on the “Physician Lists” button on the left navigation area to see two lists:
• Alphabetical:
Sorted alphabetically by physician last name, these lists include all the physicians in the Physician Organizations included in the Report. The lists include each physician’s name, degree (MD or DO) and the PO the physician belongs to; physicians who are members of more than one PO are listed in each of their POs.
• By Physician Organization:
Sorted alphabetically by Physician Organization Name. Within each PO there is an alphabetical list of the physicians who are members of the PO, sorted alphabetically by the physician’s last name. These lists include each physician’s last name and degree (MD or DO); physicians who are members of more than one PO are listed in more than one PO. Click on the name of the particular Physician Organization to go to the page listing the physicians within that PO.
Search through these lists to see if your doctor or your doctor’s PO are included in the Report. Note that only primary care physicians are included in the Report. (See "What is a Primary Care Physician?")
You may also find information about a physician by checking the physician’s PO Web site. Click on a PO’s name in the Report to go to the PO’s profile; at the top of the PO's profile page, you have the option to click on links to the PO's website (although three POs do not have a website) and a list of the PO's physicians that are included in the most recent report (2010 data). On some PO Web sites, you can find a list of doctors participating in the PO or you may be able to search for a doctor in the PO. Not all POs have a Web site at this time—some are still being developed.
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What is a Primary Care Physician?
For data from the HMOs (See "Description of HMO and PPO"), primary care physicians are doctors who specialize in Internal Medicine, Family Medicine or General Practice. For Blue Cross Blue Shield of Michigan (BCBSM), a PPO (see "Description of HMO and PPO"), a formula was used to attribute or assign patients to a physician who provided most of the member's care during the report period; for BCBSM members, this may be a doctor who specializes in Internal Medicine, Family Medicine or General Practice, or, prior to 2009, it may also have been a doctor who specializes in another area, such as Cardiology or Endocrinology.
How were these topics selected for measurement?
A team of physicians, Physician Organization leaders, health plan staff, and employers who purchase health care coverage for their employees selected the topics to report taking several things into consideration, including:
- The measurements may be used by providers to improve performance.
- The measurements are reviewed and approved by organizations that are nationally or locally recognized for this type of work, such as the National Committee for Quality Assurance , the National Quality Forum or the Michigan Quality Improvement Consortium.
- The measurements are reasonably accurate when using health plan claims data as the source.
- Methodology for the measurements has existed and been used for a number of years.
- Physicians and health plans generally agree that the measurements are reasonable.
- The measurements cover a variety of health care services, including prevention (such as cancer screening), care for chronic diseases (such as diabetes and asthma) and appropriate use of health care services (such as use of diagnostic testing for patients with low back pain).
Does a low score mean that physicians in the PO give poor care?
Not necessarily. The Report measures how often the physicians in the PO provide the desired level of care being measured. A low score can simply mean that a PO needs to improve in that one area of care. POs are working to improve health care. Many POs are helping their physicians use new systems that support high quality care, such as electronic medical records, e-prescribing or systems that track patients by condition (called "registries") to help doctors be sure patients get all needed care. Several factors can lower a PO's rate, including:
- Timing: If the test or treatment is not provided within the required timeframe, it is not counted. For example, if a childhood immunization is given after the child’s second birthday, it is not counted.
- Patient participation: Not all patients follow doctors’ advice or follow through to get the tests and treatments their doctors order.
- Data issues: The Report uses data collected from claims that doctors submit to health plans to be paid for care they provide. If a claim is not coded correctly or is lost, care that has actually been provided may not be included in the Report.
- Changing health care standards: Like other industries, health care providers strive to continuously improve; measuring and reporting the quality of health care services is a relatively new effort and as physicians get information on their performance, they look for ways to improve. (See “What Should I Ask My Doctor?”)
- Data lag: Your doctor’s performance may have changed since the most recent Report period (2010).
Why is data not available for University of Michigan Faculty Group Practice for the measure "Controlling Blood Sugar for Patients with Diabetes"?
A portion of 2007 lab results data was not available for the myCareCompare PO Performance Report only for this measure and only for one PO (U of M Med School Faculty Group Practice). The performance of the University of Michigan Faculty Group Practice for this measure cannot be accurately calculated without complete data.
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What are benchmarks?
A benchmark is like a gauge or yardstick that helps you judge how well physicians in a Physician Organization (PO) are giving care. For example, a rate of 70% may not seem like a good rate, but if most other POs are at 40%, the PO with 70% is doing much better, although there is still room for improvement.
The 2010 Physician Organization Report includes a southeast Michigan regional average; for most measures, there is also a national average. These benchmarks provide a comparison between how well a PO performs relative to physicians across the country and compared to the major POs in southeast Michigan.
The National Committee for Quality Assurance (NCQA) provided the HEDIS national average benchmarks; they are based on performance of all health plans reporting to NCQA, including HMO and PPO plans. Not all measures have a national average, either because they are not HEDIS measures or the methodology used to calculate them differed slightly from NCQA's.
The regional average benchmarks were calculated by the Center for Population Health and are based on the average performance of Physician Organizations in the region using data from all of the major commercial health plans participating in the Report. (“Commercial” health plans are those paid by private companies, or employers, rather than those paid by the government; Medicare and Medicaid are government plans, NOT commercial health plans.) For 2010, the benchmarks were developed using all the data from the three health plans, including data from POs that didn’t have enough data to be reported in the myCareCompare PO Performance Report.
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I need a doctor. How will this Web site help me?
Some people think that getting quality health care means seeing the doctor right away, being treated with respect by the doctor’s staff, or having the doctor spend a lot of time with them. These things are important, but getting the right care at the right time is even more important. We are on a journey to provide better information about quality care so that you can make the best decisions for you and your family, and form a better partnership with your doctor.
If you are looking for a primary care doctor, (see "What is a primary care physician?") this Report, along with other information, can help you decide where to seek care. Side-by-side performance rates can help you decide if you want to find a doctor in a certain Physician Organization. You can click on the Physician Organization name in the Report to go to the PO profile. At the top of the PO's profile page, you have the option to click on links to the PO's website (although three PO's do not have a website) and a list of the PO's physicians that are included in the most recent report (2010 data). On some PO Web sites, you will find a list of doctors that are part of the PO, or you may be able to search for a doctor; some of the PO Web sites include contact information so you can make an appointment. (See “How can I search for a physician in the Report?”)
Even if your doctor is not in any of the POs in the Report, the Report can help you understand how physician quality is measured and what types of things to consider when choosing a physician. It can also help you think about things you may want to discuss with your doctor. (See “What should I ask my doctor?”)
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My doctor is not listed. What does that mean?
If you cannot find your doctor listed on this Web site or in any of the Physician Organization links, it may mean:
- Your doctor was not a member of one of the Physician Organizations at the time of the Report (December 31, 2010); your doctor may have joined a Physician Organization after the data was collected.
- Your doctor may be a specialist. The myCareCompare PO Performance Report only includes data for care provided by primary care physicians (see "What is a Primary Care Physician?").
- Your doctor does not belong to a Physician Organization; not all doctors in Southeast Michigan belong to POs.
- Your doctor’s Physician Organization did not have enough data to be included in the Report.
Even if your doctor does not belong to one of the POs in the myCareCompare PO Performance Report, you can ask your doctor about the tests and treatments in this Report that have been scientifically proven to help patients. These include best practices for diabetes, heart disease, asthma medication, cancer screening, antibiotic medication, back care, emergency room use and child and adolescent health care visits. Looking at the Report can help you think about questions to ask your doctor.
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What should I ask my doctor?
You may want to ask your doctor which Physician Organization (PO) he/she belongs to. You may also want to ask your doctor about the quality and use ratings in this Report and how your doctor is working to ensure the best performance possible.
In addition, this Report can help you form a better partnership with your doctor. It shows the tests and treatments that have been scientifically proven to help patients. With this information, you can talk with your doctor about what care is best for you and your family. Here are some of the things you may want to discuss with your doctor:
- Are you receiving the right tests at the right time?
- Have you received all the immunizations and screenings that are right for your age and condition?
- Will the doctor’s office contact you to schedule the right tests and treatments at the right time – or do you need to call the doctor?
- What things can you do to be a better partner and improve your health care?
- What should you do if you have a condition you feel needs attention but is not immediately dangerous, and the office is closed or the doctor is not available?
- Which Physician Organization does your doctor belong to?
- What is your doctor and his/her Physician organization doing to improve care?
Ask your doctor questions about your care, share your medical history and information about the prescription and over-the-counter drugs you are taking, make sure that you understand your doctor’s recommendations, and take steps that will help you feel better sooner, or stay healthy. Work with your doctor and other members of the health care team to make decisions about your care. It’s one of the most important things you can do to improve your health! Click on the “Resources” link in the navigation bar at the top of this page for more information about getting the best health care and links to helpful resources.
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Where can I go for more provider performance information?
The following Web sites offer additional information about provider quality performance and give examples of provider performance information that is publicly available in other states:
- Aligning Forces Humboldt
- Health & Human Services Hospital Compare
- Health Partners Quality Measurement
- Healthy Memphis Common Table
- JCAHO Quality Check
- Kansas City Quality Health Together
- Leapfrog Group
- Massachusetts Health Quality Partners
- Minnesota HealthScores
- National Committee for Quality Assurance
- NY Health Accountability Foundation
- OR Assn of Hospitals & Health Systems Price Point
- Puget Sound Health Alliance Community Checkup
- Virginia Health Information
- Washington State Hospital Association
- Wisconsin Collaborative for Health Care Quality