"But our concern is that individual doctor level data right now is not read for prime time, especially in complex situations. The attribution of who's really responsible for that care is not worked out."
Rohack added that risk adjustment is still a big problem as well. "Some elective claim submission forms are limited in the number of co-morbid conditions they'll accept. Some take 4, 6, but the patient has 10."
In the Town Hall, many of the speakers had similar questions. Should the physician's track record on numerous care processes, such as 15 things doctors should do for a patient with diabetes, be rated individually, or will a composite for certain diagnoses suffice?
"Composites for consumers are very, very important," said Steven Findlay of Consumers Union. "(Having) 7, 10, 15 diabetes (measures) is not something most people are going to go through."
What if the doctors work in a group practice? Should the entire group be scored as well as the individual practitioner?
Should individual performance be rated for doctors who work in hospitals? And what about physicians who aren't chosen by the patient, and may never see the patient, but provide essential care on demand nevertheless such as hospitalists, radiologists, emergency room physicians and surgeons, anesthesiologists and pathologists? Perhaps there needs to be another way to score them.
"I don't think it's appropriate to put up information that's not actionable for patients," said one speaker who said he represented the American Society of Anesthesiologists. "Comparing anesthesiologists to anesthesiologists is not necessarily the best way to do things."
Will the scoring system rank 90% of the doctors as average or "good," eliminating much of the variability?
And what about patient satisfaction scores? How will they be rated and what measures will be used? Is it important to show how long patients had to wait to get an appointment and whether the physician was always on time?
Some of the speakers argued that the more information that is put on the website, the better for all. Others said that if there is too much data, it will fail in its primary purpose.
"It seems to me that some research in the past has indicated that more information is not necessarily better for consumers," said Ed Mendoza of the California Office of Statewide Health Planning and Development, which operates the nation's largest hospital discharge database. "You can have so much information that you disengage people before they've had a chance to think about choice."