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About the Medical Group Ratings

Patients Rate Medical Group

It is important to know what patients think about the care and service they get from their medical groups. To find out, surveys were done with more than 70,000 California patients between the ages of 18-64. All were patients who had a visit with a doctor in a medical group during 2005.

Patients answered many questions about their experiences with their doctors and medical groups. Then, we organized the answers into five categories:

The medical groups were rated on these topics based on patients’ survey answers. Typically, 35%-45% of patients who are contacted answered the survey. Four of the five topics were formed by grouping sets of related questions and combining the scores for these questions into a topic score. The Patients Rate Medical Group summary rating was formed by combining the results of the other four topics into a single summary score.

Scoring and Rating Methods: Patients Rate Medical Group

Medical group scores were based on patient responses to the Patient Assessment Survey (PAS). Adult patients from more than 180 California medical groups and Independent Practice Associations (IPAs) responded to the survey. Patients are asked to rate the care and service provided by their doctors and other staff in the medical group during the past year (2005). The mailed questionnaire was available in English, Spanish, Chinese, Korean and Vietnamese. About 20% of the patients who responded completed the survey by phone and the remaining 80% answered and returned a mailed survey.

Scores for the four topics are based on the mean score of the patient’s responses to the survey questions. For most questions, responses are scored using one of six possible answers ranging from the patient “always” had a positive experience with a particular need like getting an appointment to the patient “never” had a positive experience. Each patient’s responses for a set of related questions—like “coordinating patient care”—are combined to create a per-patient topic mean score; then the average of all of a medical group’s patients’ scores is calculated to create a medical group score for that topic. The scores represent the average or typical experience that that medical group’s patients reported.

The Patients Rate Medical Group score is calculated by combining the scores for the four topics. The four topic scores are combined by giving them equal weight and calculating an average score. The score for Patients Rate Medical Group is given one of four performance grades that are indicated in the report card with stars. The possible grades are:

  • Excellent: This means that 87% or more of medical group members reported a good experience.
  • Good: This means that 80%-86% of medical group members reported a good experience.
  • Fair: This means that 73%-79% of medical group members reported a good experience.
  • Poor: This means that fewer than 73% of medical group members reported a good experience.

Using a “buffer zone” adjustment, we account for the error that occurs in measurement and scoring when the formula is based on samples of members rather than all the members in a medical group. This “buffer zone” gives the benefit of the doubt to the medical group—if a score falls below a performance threshold, (e.g., a score of 87 marks the excellent grade) but within one point of that threshold, the medical group is assigned that next highest grade.

The scores are adjusted for a set of patient characteristics—age, gender, mental health status, education, overall health status, race/ethnicity, language spoken and number of chronic conditions—that have been shown to influence patients’ ratings of their care experience. These adjustments allow us to make apples-to-apples comparisons across groups whose patients may differ. Through the adjustments, which result in very small changes in a medical group’s scores, we can represent the groups’ results as if they all had a similar mix of patients.

“Too Few Patients” and “Not Willing to Report”

On the medical group rating charts, most columns have a score from one to four stars, with four stars being the highest rating. Sometimes you will see one of the following:

Too Few Patients: This means that the medical group did not have enough members who had the experience to be scored.

  • The Patients Rate Medical Group measures are not available for all medical groups for several reasons. In some instances too few patients answered particular questions to report that result. This typically occurs with some smaller medical groups that have fewer patients; their results may not be accurate because of the low number of completed surveys. In other situations, the question is about an experience that is relevant to fewer patients in that group and we are not confident that the results represent typical patient experiences with that medical group.

Not Willing to Report: This means that the medical group would not report its results. This usually means that the medical group did not do well and does not want to share the information.

How Reliable Are the Scores?

Enough people replied to the survey and we looked at enough records from the medical groups to give a clear picture of how well each medical group is doing. However, your experiences may be different from the ratings shown here.

The Patient Rates Medical Group rating is based on patient surveying that is done in a way to show the typical experience of patients in each medical group. The patients who were surveyed were randomly drawn from the medical group’s full list of commercial HMO members. Patients who had a medical visit in 2005 were included on the survey list. Results were from patients with visits to their primary care doctor and other patients who had visits with specialist doctors. Nonetheless, your experience with a particular doctor or medical group staff may differ from the experiences reported in the survey.

Comparing Medical Group and HMO Ratings

An HMO is a type of health insurance. A medical group is a group of doctors who work with an HMO to give the HMO’s members their medical care. You should not compare the ratings for HMOs and medical groups because:

  • HMOs and medical groups keep different kinds of records. This means that the information we get from them is different.
  • We did not always study the same members when we looked at medical groups and HMOs, even when we were rating the same health topic.
  • We used medical charts to get information about HMO performance. We did not use medical charts to get information about medical group performance.
  • The quality of the care that HMOs and medical groups give is measured in different ways. The way HMOs and medical groups are rated also differs.

California Cooperative Healthcare Reporting Initiative

The California Cooperative Healthcare Reporting Initiative (CCHRI) is a group of employers, health plans, and health care providers across the State. More than 90 percent of HMO members in California belong to plans that are part of CCHRI. CCHRI makes sure that people get information they can trust on how well health plans and medical groups provide care and service.

CCHRI also directed the Patient Assessment Survey (PAS) to measure and report patients’ care experiences. The results of that survey are shown in the Patients Rate Medical Groups part of this report card. Along with the participating medical groups, the following HMOs financially supported this survey:

Patients Rate Medical Group

Excellent

This means that 87% or more of medical group members reported a good experience.

Good

This means that 80%-86% of medical group members reported a good experience.

Fair

This means that 73%-79% of medical group members reported a good experience.

Poor

This means that fewer than 73% of medical group members reported a good experience.

Too few patients in sample to report

This means that the medical group did not have enough members who had the experience to be scored.

Not willing to report

This means that the medical group would not report its results. This usually means that the medical group did not do well and does not want to share the information.