Back in 2011, just before Medicare named the 32 providers who would test new ways to deliver care with better quality and lower costs, Don Berwick, then the leader of the Centers for Medicare and Medicaid Services (CMS) said, “for Medicare, coordinated care represents the most promising path toward financial sustainability and away from alternatives that shift costs onto patients, providers, and private purchasers,” in this New England Journal of Medicine article.

So when Berwick (who is also seriously considering a run for governor of Massachusetts) said last week that he’s advising some Pioneer ACOs in their dispute with CMS about how to measure quality, my ears perked up. Today, he clarified that he’s only spoken to one ACO executive who called to ask for his advice. Berwick points out he can’t, in accordance with federal ethics rules, get involved in direct negotiations.

Berwick says it’s important to “stay on the high road with respect to the purposes here. The idea of ACOs is important and it (quality) is an important component in the whole move toward integrated care. So let’s not throw the baby out here.”

Berwick, who is also busy helping Britian’s National Health Service recover from an “enormous illness”, offers the Pioneer ACOs some guidance.

“As you work through solutions, stay on the high road. And then, try to get to a platform where the discussion is not, will we play or not, but can we work this through at a technical level.”

The Pioneers may well create quality standards that will be put to use in hospitals across the country. Berwick explains the challenges.

“It’s very important to align metrics in this country so we don’t have so many. We have this chaotic measurement environment where the number of things people have to report is crazy so some of what has to be kept on the table is, let’s simplify and make sure the metrics align. That vocabulary is really important.”

The 32 Pioneer ACOs have told CMS they need to know before April 2nd, if the feds will accept provider recommendations on how to measure quality.

CMS is under increasing pressure from Republicans on Capitol Hill to prove that the Pioneer ACOs are worth the investment.

We’ll keep you posted. Let us know if you hear anything!

All Martha Bebinger wants is a good colonoscopy. Don’t we all? But look at the lengths she has to go to in order to find out which doctors are good, who finds the polyps and what the actual cost of the procedure is. Her search shows that while everyone in health care talks about the importance of transparency, it’s not here yet. Here’s the top of Martha’s story:

Someday soon, you’ll need a routine medical test, perhaps an ultrasound or a mammogram, and you’ll obviously want the best. But the quality of health care tests and procedures can vary a lot depending on the doctor or hospital, and it’s not easy for patients to find information about quality.

Still, we’re all supposed to be choosing our care more carefully these days. So when I got a scribbled note from my doctor saying that it was time for a colonoscopy, I set out to find the best one in Boston.

I used to think a colonscopy is a colonoscopy, just one of those tests we have to get when we hit middle age. Then I met James Tracey, a gastroenterologist (GI) who does more than a thousand colonoscopies a year. He starts telling me about this running competition he has with other GI docs, one in particular at Hawthorn Medical Associates in North Dartmouth. It’s about who has the highest rate for finding polyps in patients during a colonoscopy.

“When he and I walk down the hall, it wouldn’t be uncommon for him to mention his percentage just to get me going,” Tracey says. “And of course that redoubles my effort that I’m not going to have that edge over me! I’m going to make my numbers as good as his.”

Tracey tells me some doctors in his practice find polyps in twice as many patients as others. Hold on, I think, this seems pretty important. I’m getting this not-so-pleasant test to look for adenomas, those polyps that can develop into colon cancer. So I ask Tracey, why is there such a big difference? He reminds me the colon is a five- to six-foot-long tube packed into the abdomen.

“Sixty to 70 percent of the colon you can see clearly, no matter what you do,” Tracey explains. “But 30 percent of the colon, you need to work at it. You need to irrigate the colon out if there’s any fluid or debris. You need to reexamine an area several times if the anatomy is distorted so the colonoscope cannot clearly see.”

My takeaway is that some doctors look more closely for polyps than others. And, of course, patients play a big role here. If we don’t follow the prep instructions, such as fasting, and come in for this test with a clean colon, the doctor is not going to have a clear view of potential problems. OK, enough description. So I make a list, based on conversations with doctors, of ways that one colonoscopy can be better than another. I email the list to some large hospitals and physician groups in Greater Boston and ask them how they measure up.

At this point, with or without solid quality data, patients must take a more activist role in their own care, Martha says:

For now, if you need a colonoscopy, be sure you ask at least one question: How often does your doctor find adenomas, the polyps that can develop into cancer? That answer is important.

If you really want to find the best “value” colonoscopy, try comparing the quality chart [top] and the cost chart… Both are rough. The quality information has not been cleaned up or adjusted for the sickness of patients. And on the cost chart, some of the prices you see are based on what my insurer, Blue Cross, would pay, and some aren’t. This isn’t close to what we patients need to make smart choices, but it’s a start.

Politico notes that three new films exploring various broken aspects of the health care system — overtreatment, high cost, lack of access and more — are all coming out in the next few days:

We haven’t seen them all ourselves, but just so you know: “Money and Medicine,” shot at UCLA Medical Center in Los Angeles and Intermountain Medical Center in Utah, airs on PBS tonight. “The Waiting Room” goes inside a safety net, Oakland’s Highland Hospital, and it premieres Wednesday in New York. And “Escape Fire,” which we mentioned last week, has held screenings in several cities and med schools and goes into wider release next week.

Maureen Bisognano, CEO of the Institute for Healthcare Improvement here in Cambridge, offers a few more details on Escape Fire, which was inspired by a speech by her predeccessor, Don Berwick. Writing on the IHI leadership blog, she says:

The title is probably familiar to a lot of you since it’s inspired by Don Berwick’s 1999 National Forum keynote in which he recounts the use of a radical approach to wildfire survival —- setting your own smaller fire to prevent the larger fire from overwhelming and consuming you —- and offers this “disruptive (even counterintuitive) innovation” as a metaphor for what’s needed in health care. Don appears in the film, along with journalist Shannon Brownlee, prevention advocate and wellness expert Dr. Andrew Weil, and a host of other innovative leaders in health care.

The film closely follows the often heart-breaking challenges patients and clinicians face as they try to treat, and be treated, in a fragmented, costly, and often ineffective system. I was particularly struck by the account of a young primary care physician from Oregon, and her agonizing decision to leave a practice that was not meeting the needs of her patients, and not satisfying her professionally. The hope and renewed energy she found in pursuing a fellowship and practicing in a new model underline the power and promise of redesigned systems of care.

WBUR’s Martha Bebinger offers her thoughts:

A Health Affairs report out last week concludes that a relatively new global budget contract in use by Blue Cross Blue Shield of Massachusetts has “improved care.” Hold on. If this is the threshold for success, then the move to global budgets is going to disappoint a lot of regular, non-medical people, like me.

Take a closer look at the evidence of “improved care” in the report. There are two charts (and summaries, both are below). The first includes scores for 21 ways to measure whether patients received recommended preventive or maintenance care. The second looks at whether patients with diabetes, hypertension and cardiovascular disease are more likely to have their ailments under control with care through a global budget than through fee for service. Yes, there is some evidence that patients are receiving better preventive care.

But to me, “improved care” should mean more: Are patients in a global budget healthier, happier and more productive than those who receive are through traditional fee for service? I understand that measuring “health” is really hard. One quality guru told me that the U.S. has not expanded ways to measure health care quality since we started using HEDIS in, was it the early ’90s? OK, but if you can’t tell me I will be healthier under a global payment, then don’t make the claim.

Here are some examples of things I want to know when comparing patients in and outside a global budget:

1) Do your kids with asthma miss fewer days of school?

2) Do adults diagnosed with depression miss less work?

3) Are patients readmitted to the hospital for the same or a similar ailment less frequently?

4) Do patients develop fewer hospital acquired infections?

5) Do moms suffer fewer complications after a normal vaginal delivery?

I don’t want to minimize the importance of helping diabetics keep their blood sugar under control. This is important. But I need more clear, understandable proof of “improved care.” Is it out there?

Here’s the chart on the 21 preventive and maintenance measures:

On the chart that looks at chronic disease management control, here’s what the report says:

Formal evaluation of outcome quality measures could not be conducted because of the lack of pre-intervention enrollee-level outcome data. However, an unadjusted analysis of weighted averages for five outcome metrics across provider organizations suggests that intervention groups achieved better or comparable outcomes in 2009–10 relative to recent Blue Cross Blue Shield of Massachusetts network averages.

And here’s the chart:

Diagnosed with an immune system disorder, sarcoidosis, Bollinger has near-constant joint pain, trouble breathing, deafness in one ear and a slew of other symptoms that prevent her from holding a job, she says.

She’s on MassHealth, the state’s subsidized Medicaid program for low-income residents. But Bollinger says that as soon as she steps into the doctor’s office, she enters a world in which she feels inferior — rushed, ignored and discounted at each step. “I call it assembly-line health care,” she says. Doctors have abruptly stopped her from talking by putting a hand in her face, suggested she’s addicted to painkillers and left her alone in an exam room in the middle of a medical history, seemingly too busy to take her myriad symptoms seriously, she says. Although Bollinger reports that she was assigned a primary care doctor five years ago, she’s never seen her: that doctor’s schedule is always full. So Bollinger says she just takes whichever provider happens to be free.

“I’m treated horribly,” she says. “I want my doctor to be thorough even if it takes more than five minutes. Frankly, I’m embarrassed to be on MassHealth — they think, ‘Oh, you’re poor, you must be a drug addict.’ Or, like, ‘Your insurance doesn’t pay me enough to be thorough.’ ”

Despite nearly universal health insurance coverage in Massachusetts, which has clearly helped residents, mainly the poor, gain access to medical care, disparities persist.

Bollinger says she has a friend with renal cell cancer who is covered by private insurance and experiences health care in an entirely different, more humane manner. “She has Blue Cross and they treat her like a queen,” Bollinger says. “They pay for her transportation, and her primary care doctor, on days off, calls her just to check in.”

It’s tough enough being sick, but when you’re sick and poor, you’re far more likely to experience long waits and care that leaves you unsatisfied and feeling discriminated against because you’re on Medicaid or other public insurance.

In our poll, Sick in Massachusetts, we asked residents who said they had a serious illness, medical condition, injury or disability requiring a lot of medical care, or spent at least one night in the hospital within the last year about their experiences. We found that sick people with lower incomes (under $25,000) are significantly less likely than middle-income (from $25,000 to $74,999) and higher-income folks (over $75,000) to say they are very satisfied with their care. And more than one-fourth of the lower-income sick report that they were treated worse than others because of their insurance status, a significantly higher proportion than for middle-income (13%) and higher-income (2%) sick.

Robert Blendon, of the Harvard School of Public Health conducted the poll and this morning told WBUR: “…in a world where we’re so pleased with universal coverage, beneath the surface there are still people who think they’re being treated differently based on their insurance.”

A Snarky Tone And A Long Wait

“I felt I was treated like a second class citizen,” said Charlene Wallace, 61, who is on Medicare (due to disability and death benefit income, she earns $4 too much to qualify for MassHealth, she says). Wallace used to visit a clinic in Lowell for her Chronic Obstructive Pulmonary Disease (COPD), chronic bronchitis, high blood pressure, arthritis, restless leg syndrome and recent heart attack, for which she takes a total of 20 medications. “When I asked why I had to get a urine test every month, the nurse raised her voice and said ‘Because you have to, that’s why.’ You have an appointment at 11 and you’re there for three hours,” she said. “Even just to pick up a prescription, I’m there an hour and a half.”

Indeed, according to our poll, half of the lower-income sick said they had to wait longer for an appointment than they thought reasonable, a significantly higher proportion than for middle-income (32%) and higher-income (27%) sick. The poll was conducted by the Harvard School of Public Health, the Blue Cross Blue Shield of Massachusetts Foundation and WBUR.

What the poll, which surveys 500 “sick” residents of Massachusetts, shows overall is that despite widespread insurance coverage here, patients still experience serious problems related to the cost and quality of care. The poll found that about one third of sick adults report that the cost of their medical care has caused a “very serious” or “somewhat serious” financial problem for their family; and one in seven sick adults say there was a time in the past year they couldn’t get the medical care they needed, either because they couldn’t afford it or their insurer didn’t cover it.

Collection Agency Blues

Bonnie McGhee says the quality of her care is fine, but even on Medicare, she can’t pay for everything she needs. At age 67, she’s got severe, “brittle” diabetes, neuropathy, acid reflux and heart problems. Medicare pays 80% of her drug costs, but she still has a hard time paying the other 20%, she said, and has already stopped taking certain medications to save money. Two years ago, she was admitted to Cape Cod Hospital six times due to extreme spikes in her blood sugar levels and other problems related to the diabetes. She still owes about $2,000 for those visits. “The collection agency keeps writing me.”

To pay for her insulin, McGhee works summers as a parking lot attendant in Provincetown — 10 hours a day, four days a week. “Physically it’s hard,” she says. “I get very tired easily — I have neuropathy in my legs, so I don’t walk right. I can do this job because I can sit in a booth.”

Nancy Turnbull, an associate dean at the Harvard School of Public Health, and not involved in the poll, said she thinks the survey shows the effects of insurance coverage expansions in the state because “there are very few significant differences between lower and higher income people [when it comes to] access, financial barriers to care and almost every other measure.”

But,” she says, “while insurance coverage reduces disparities in care for lower income people, it doesn’t eliminate them. So it’s not surprising that there are still differences in the survey. Lower income people are more likely to be in limited network plans, and so have less choice of doctors and hospitals. Rising co-payments and deductibles lead people with less income to delay care, get sicker and then need appointments more urgently, appointments that might be hard to obtain in a timely way. They could be more likely to live in areas that have worse access to care than in richer areas. Poorer people encounter bias and prejudice in the health care system — against the poor, against people who have Medicaid, against people of color (who are more likely to have lower incomes). So while insurance is tremendously important, it does not equalize the health care system for lower income people.”

You can view the report, Sick in Massachusetts, here and the detailed results here. And here’s this morning’s WBUR interview with Blendon, who conducted the poll.

The Blue Cross Blue Shield of Massachusetts Foundation, the Harvard School of Public Health (HSPH) and WBUR worked in partnership to produce “Sick in Massachusetts.” The Foundation commissioned and funded the HSPH poll. An independent research firm, SSRS, conducted the telephone interviews and provided WBUR with the names of poll participants. WBUR met with the partners to review the poll questions and analyze the results. WBUR shared story scripts with Robert Blendon at HSPH for fact checking purposes. WBUR, using internal editing procedures, decided how to frame and expand on issues raised by the poll results.

The first-in-the-nation ratings, which you can find here, include 329 adult practices and 158 pediatric practices around the state and are drawn from MHQP’s statewide patient experience surveys, conducted every two years since 2006. Consumer Reports is producing a special version of the magazine for distribution in Massachusetts with a 24-page section, “How Does Your Doctor Compare?”

You can’t see how your individual doctor is ranked, but you can look up how his or her practice rates on a range of quality measures, all from the patient’s perspective. These include how well physicians communicate with their patients and coordinate medical care; how well they know their patients; hoe well they give preventive care and advice; and whether patients would be willing to recommend their doctor to family and friends.

The patient experience survey, which includes 47,565 adults and 16,530 parents of children (all with commercial health insurance) also includes questions on patients’ feelings about the rest of the office staff: the nurses, receptionists and the folks who deal with billing and insurance. (Practices had to have at least three physicians to be rated.)

As more patients buy high-deductible health insurance plans and pay more of their own money for medical care, these types of quality ratings will take on added importance, says Barbra Rabson, Executive Director of Massachusetts Health Quality Partners “The need for this information is escalating,” she says. “As we are totally engrossed in health care reform and payment and delivery reform, we want it to be patient-centered. If you don’t have the patient voice, how will it be patient-centered?”

Rabson says that in general, care has improved over the years, with the most improvement in how doctors coordinate care. Here are some of the findings, according to the joint Consumer Reports and MHQP news release:

– Sixty-three percent of survey respondents said their doctor was always informed and up-to-date about the care they received from specialists. Consumer Reports recommends that patients make sure doctors know about the care they get from other providers, including other physicians as well as acupuncturists, chiropractors, herbalists, and other alternative health-care practitioners, and make sure they coordinate with your doctor as well. That can help to improve the quality of care and avoid duplicative care.

–Seventy-two percent said someone always followed up with them to provide results on blood tests, X-rays, or other tests. If patients don’t get test results in a timely manner, or when their doctor promised them, they should call. And they should request a written copy for their files. Some practices use a secure online portal that provides access to test results and other information.

–Fifty-seven percent said the front-office staff was always as helpful as they should be. Patients should have patience, but let the staff know if they expect them to be more helpful. Patients who ask for more help are likely to get it. If they don’t get the help they need, they should follow up with the office manager.

–Thirty-eight percent said they didn’t always get an appointment for care they needed right away and the same percent said they didn’t always get after hours advice they needed right away.

–Sixty percent of patients said they didn’t always get taken to the exam room within 15 minutes.

–Forty eight percent said they weren’t always seen by their provider within 15 minutes after being taken to the exam room.

The survey of 64,000 Massachusetts residents cost about $800,000, Rabson said, and was paid for by the state’s largest health insurers, all members of MHQP, including Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Tufts Health Plan, Fallon Community Health Plan and Health New England. MHQP describes itself as “a broad-based coalition of physicians, hospitals, health plans, purchasers, patient and public representatives, academics, and government agencies.”

For more on the surveys, here’s a bit of WBUR’s Martha Bebinger’s interview with Rabson:

Rabson: What we are hoping is that this report can help patients answer questions like…How well do my care priorities line up with my doctor’s? How can I talk to my doctor about what matters most to me in terms of my health care? How can I work with my doctor to improve the care that I get? What should I expect from my doctor and his or her office and how do I ask for what I need?

Bebinger: Do you feel like we are making progress in terms of patients understanding how to be more engaged in their health care or having the tools they need to be more engaged?

Rabson: I think what is happening in our environment that is changing so rapidly is that patients are now being forced to make more and more decisions about where they go for care, how much of their care is paid for, and we are in a position where we are asking patients to make cost-quality tradeoffs or cost-convenience tradeoffs and it is one thing to ask somebody to make that decision if they have the information they need to make those decisions but in our situation, sometimes patients are forced to make these decisions and they do not have any information. So part of what is happening is this environment is forcing us to make more decisions that have a greater impact on our care, that we were not making before.

Bebinger: Do you feel like you are seeing signs that patients are using this data and is it changing the way they interact with doctors?

Rabson: I think what we are seeing is a shift in the relationship between the patient and the doctor, and this is a shift that has been going on for many years when the doctor made the decisions on behalf of the patient for the patient and so we are moving into this era of shared decisions making.

And with shared decision making you need a partnership so we are expecting patients to be more engaged so they can work closer with their physicians. And this is something that has to change culturally both on the side of the patient and on the side of the physicians and some physicians and patients are more comfortable with this.

We feel that by getting people some information about physician-patient interaction, about the patient experience. It is important to give that feedback to the doctors so that they better understand what their patients are experiencing and so they can do more to engage their patients and related to them more closely.

And on the patient side, having this information so they know what can be accomplished in a visit, what you could expect you should be getting or should be talking about or you should be engaging about. And so having some data, I believe, helps push this process along. It’s evolving slowly but the market is changing incredibly quickly and so we feel that having this information in front of patients and in front of doctors is key.

And here’s Martha’s interview with John Santa, Director, Consumer Reports Rating Center:

Bebinger: And this is the first time that Consumer Reports has stepped into this area of physician rating, is that correct?

Santa: Well this is the first time we have done primary care physician practice site ratings. We have done some heart surgery group ratings in the past but this release is really much more broad and gets down to the primary care level.

Bebinger: And why are you moving into this area?

Santa: Well, we think that patient experience is important to consumers and that a more robust scientific approach, like the one taken by Massachusetts Health Quality Partners, is the way to go. We think it’s an approach more consistent with Consumer Reports rather than relying on user reviews. And we’re also interested in how it will work for us to work with a local partner … someone who is there in the community, who is most likely to get the names of the medical groups right, their addresses, phone numbers etcetera. Those are the two most important elements to us. This is great data. We want consumers and especially our subscribers to see it.

Bebinger: Are you hearing or do you expect a lot of demand for this information?

Santa: We know from surveys of our own subscribers and the general public that health is number one when it comes to folks wanting more information, wanting information on the internet. And we know that information about physicians is at the top of their list. And we are quite confident that once we get it right, and it can take a while to get it right. We have learned that through decades of doing comparisons but once we get it right we think this will be very valuable data to consumers.

Bebinger: Do you think that eventually you will need to have it at the physician level for it to be as powerful as consumers expect?

Santa: Yes. For example in the case of many specialists who do surgical work I think it will be very important eventually to give consumers a sense of individual performance. At the primary care level, having practiced for thirty years, I think both the practice level and eventually an individual level are important. For most of us in practice, thirty to forty percent of the care our patients get comes from our partners. Because we are on vacation, we’re on call, we can’t fit somebody in so most primary care offices are really taking care of patients as practice site. So both elements are important. It is just harder to get it down to the level of the individual physician and get enough data to be confident in reporting.

Bebinger: Where else, then, is Consumer Reports headed in this arena of trying to give consumers more information about health care?

Santa: I think the four things that we think are key are…one, you need to get the names of the doctors and the groups right. And their contact information. Two, having a scientific sense of what the experience of care is like is important. Three, actual outcomes. How well are you likely to do? And then four, cost. Those four things we think are key. The release today in Massachusetts covers two of them so we are happy that we are making steps towards getting all four.

Bebinger: Actual outcomes and costs being the two that you are making steps towards?

Santa: Well that’s right. MHQP does have clinical outcomes information available on their website. We just felt in the case of this project, we should focus on patient experience. And then cost data I think is yet to be developed. Lots of folks interested in that so we will see how soon and how much of that data comes forward.

Santa: I think that what is great is that this is public reporting. This is reporting that consumers can see. I think that makes a huge difference in terms of the way health care is provided. When physicians and hospitals and other folks in the health care industry know that their care is going to be reported to the public I think the data is very good. They start to improve significant so every time we do this we feel like we are helping that process along.

1. Multiple Factors Undermine Transparency

“Several health care and legal factors may make it difficult for consumers to obtain price information for the health care services they receive, particularly estimates of what their complete costs will be. The health care factors include the difficulty of predicting health care services in advance, billing from multiple providers, and the variety of insurance benefit structures.”

2. Questioning Tests and Insurance Status

“For example, when GAO contacted physicians’ offices to obtain information on the price of a diabetes screening, several representatives said the patient needs to be seen by a physician before the physician could determine which screening tests the patient would need. According to provider association officials, consumers may have difficulty obtaining complete cost estimates from providers because providers have to know the status of insured consumers’ cost sharing under health benefit plans, such as how much consumers have spent towards their deductible at any given time.”

3. Illegal Sharing?

“In addition to the health care factors, researchers and officials identified several legal factors that may prevent the disclosure of negotiated rates between insurers and providers, which may be used to estimate consumers’ complete costs. For example, several insurance company officials GAO interviewed said that contractual obligations with providers may prohibit the sharing of negotiated rates with the insurer’s members on their price transparency initiatives’ websites. Similarly, some officials and researchers told GAO that providers and insurers may be concerned with sharing negotiated rates due to the proprietary nature of the information and because of antitrust law concerns.”

The report looked at pricing transparency initiatives in several states, including Massachusetts, which offers data on cost and quality on the My Health Care Options website. However, the GAO report found that “certain factors limit the extent to which this type of information is made available.”

“For example, the Massachusetts initiative has access to claims data that could be used to provide more complete cost estimates to consumers, such as negotiated discounts for commercial insurers. However, it presents price information that aggregates the prices paid by commercial insurers for particular services, in part due to insurers’ and providers’ concerns about the initiative disclosing price information by insurer. As a result, consumers are unable to see an estimate for a particular provider that is specific to their insurance company or to calculate their out-of pocket costs based on their specific plan.”

Looking ahead, the GAO recommends that the U.S. Department of Health and Human Services “determine the feasibility of making estimates of complete costs of health care services available to consumers, and, as appropriate, identify next steps.”

(Hat tip to Joshua Archambault of the Pioneer Institute, which highlighted the state website’s low user numbers in a report last year.)

The study, which appear in The Annals of Internal Medicine, concludes:

High-performing hospitals were characterized by an organizational culture that supported efforts to improve…care across the hospital. Evidence-based protocols and processes, although important, may not be sufficient for achieving high hospital performance in care for patients…

In other words the culture and priorities of a hospital may be as important as its medical protocols in terms whether you live or die after a heart attack.

Or, as the story says:

…the presence of a “strong organizational culture” was associated with variances in death rates of as much as 9.5 percentage points.

The researchers conducted interviews with a total of 158 staffers — all involved with heart attack care — at 11 hospitals across the U.S. They found few differences in what protocols the hospitals used in treating heart attacks, but big ones in how hospitals were managed and how they approached quality improvement.

“It’s not so much what they’re doing but how they’re doing it,” Leslie Curry, a researcher at Yale’s Global Health Leadership Institute and lead author of the study…

High turnover among nurses was also a trait of hospitals with high 30-day mortality rates, the researchers found.

Using mistakes as learning experiences as opposed to reasons for punishment was another characteristic of top performers, Curry says. And views of nurses, pharmacists, technicians and even housekeeping staff were highly valued in the team approach used at the best hospitals, she added.

Hot off the presses: New data that let you compare your primary care doctor to others statewide on 25 national measures of care, from diabetes to asthma to depression to the simple sore throat. WBUR’s Martha Bebinger reports:

Primary care doctors in Massachusetts are above the national average when it comes to providing preventive care, but there are still wide gaps in the quality of care they deliver.

“What that means is that you’re not getting the same care when you go to different doctors,” says Barbra Rabson, the executive director at Massachusetts Health Quality Partners (MHQP). “As patients we need to look and see how our physicians are doing because we want to make sure we’re going to physicians that are providing the best possible care,” adds Rabson.

MHQP surveyed more than 4,000 primary care doctors for this latest score card on the quality of physician care. The findings show, for example, that many physicians prescribe antibiotics for a sore throat without knowing if their patient has strep. Patients can look for their physician’s results here.

Here’s how MHQP sums up the latest data:

Primary care physicians in Massachusetts are making strides to improve overall care by closing gaps in variation, according to MHQP trend data. For example, colorectal cancer screening is one area of improvement. The screening rates have improved by eight percentage points over the last three years (from 69 to 77%) and variation among medical groups has shrunk by 10 percentage points (from a 47 point difference to a 37 point difference).

But there are areas where not all health care in Massachusetts is the same. When measuring how often a group tested children with a sore throat for strep when prescribing medicine, some groups gave the recommended care 100 percent of the time, while others did so only 37 percent of the time. A variation of 63 percentage points means that patients do not get the same care in every doctor’s office and that some doctors provide patients with a more appropriate level of care.

And here are some wonderfully succinct points fromthe MHQP release:

 Overall, Massachusetts’ primary care physicians provide high quality care. Massachusetts’ statewide results are above the national average on 24 of 26 (92%) process of care measures (such as screening rates of testing for colorectal and breast cancers) and all five (100%) of the outcome measures (such as improvements in blood sugar levels for patients with diabetes).

 In all regions of the state, quality varies among medical groups. It matters where a patient goes to get care. For example, the variation in long-term monitoring of medication for depression varies by only six percentage points among regions. However, within a region such as Metro Boston, this care varies by 42 percentage points between the lowest and highest performing groups (33 to 75%).

 Large gains have been made since MHQP started reporting. The greatest improvements have come in women’s health care with two chlamydia screening measures, which made 15 and 21 percentage point increases respectively over the seven years MHQP has been reporting these two measures.

 Over time, scores are improving. Some statewide measures have increased significantly in the seven years since MHQP started reporting. Well care visits for adolescents have increased from 67 to 74 percent over this time period, an improvement of seven percentage points. This score is also well above the national average, which comes in at 44 percent.

-Reporting on differences in quality of care is critical as Massachusetts moves to enact legislation to improve health care delivery and meet the goals of health care reform. MHQP has been releasing data on clinical quality in primary care for the last seven years, serving as a primary resource to track trends of care in Massachusetts.

MHQP is “a non-profit, broad-based coalition established in 1995.” Readers, if you try checking out your primary care doctor, please let us know your experience in the “comments” section below.

So yes, I was baffled yesterday. I was trying out the revamped state Website for comparing medical care — a kind of Zagat guide with $$$ ratings for cost and **** ratings for quality. And it seemed to be sending me to the Dana Farber Cancer Institute for heart attack care and weight loss surgery. True, Dana Farber was the closest hospital to my zipcode, but still. Heart attack? The Farber???

I understand better now. The site’s creators tell me that after much debate, they decided to include all the hospitals near your zipcode, even if there’s no data on what you’re looking for, to show that the hospital has not just been omitted somehow.

“Its positive information that there’s nothing there for you,” said Sally Okoniewski, the Website’s manager.

If a hospital near you has no information on a condition, it either means that the place doesn’t treat it or there’s no statistically significant data on the results, said Jessica Moschella, administrative director for the state Health Care Quality and Cost Council, which runs the site.

Some cool new features on the site:

-It now includes not just hospitals but medical groups.

-If you’re comparing costs, you can pit hospitals head to head and see a nice bar graph of how they rate. For example, let’s say I need a mammogram, and I want to compare costs at the Lahey Clinic, Emerson Hospital and Winchester Hospital. Here’s the bar chart I get, with Emerson mostly cheaper and the Lahey mostly more expensive, but some overlap.

The site is gathering more user feedback and data on cost and quality all the time. My dream is that it turn into something like the travel Websites I use to find out which hotels have rooms available for the dates I want. Only instead of Montreal for three nights in May, it would be gynecologists near downtown Boston…