Publicly reported physician ratings: here to stay but not yet ready for prime time.

Public reporting of physician performance—whether user-generated physician rating websites or metrics-driven, scientifically based performance reports—is a reality of health care today and is increasingly tied to high-stakes outcomes, including reimbursement and compensation. With the rise of the consumerism movement, more and more patients are proactive in choosing their providers and are increasingly turning to the Internet to make their selection and to voice their opinions about providers with whom they have interacted. In the past, patients’ conversations about their physicians largely consisted of informal discussions with friends, family members and acquaintances that extended no further than the two or three individuals involved. With the Internet, these conversations now have rapid and widespread distribution via online physician rating websites. And they can affect physicians’ reputations. The stakes associated with metrics-driven physician performance assessments are also greater than in the past. As the cornerstone of the delivery system, physicians exert significant influence through clinical decision-making on the quality and cost of health care.1 Many stakeholders are looking to individual physician performance ratings with the goal of standardizing care with best practice guidelines and thus improving quality and cost efficiency. Governmental agencies, payers, advocacy groups and consumers are more frequently demanding transparency in physician performance than in the past, as a means for improving the quality and cost efficiency of health care. Payers are using rating systems to identify physicians deemed to provide care of higher quality and greater cost efficiency and are offering patients benefit plans that incentivize the selection of higher-ranking physicians. As the outcomes of physician ratings are increasingly tied to reimbursement and compensation, the validity, reliability and relevance of these systems becomes crucially important. It is important for physician leaders to understand the current state of physician ratings systems, the likely future trends, the potential utility and negative consequences of ratings systems, and how to best guide their organizations to make the most of the opportunities afforded by these systems and minimize the potential risks.