Minnesota patients reveal the best and worst clinics

The customer ratings that influence everything from the books people read to the jeans they wear are now coming to medical care in Minnesota.

Patient satisfaction ratings for 651 primary care and specialty clinics were released Wednesday by the Minnesota Department of Health and a nonprofit called Minnesota Community Measurement, expanding the state's eight-year effort to place health care quality data in consumers' hands.

The new report ranks clinics in four categories: availability of timely appointments, courtesy of clinic staff, communication skills of the doctors and overall doctor quality.

"We now have a statewide measure that can paint an accurate picture of the patient experience," said Jim Chase, executive director of Minnesota Community Measurement.

Minnesota is the first state to publish patient satisfaction data on such a large scale, according to state Health Commissioner Dr. Ed Ehlinger. He said he anticipates that patients will use the data to select doctors, and health insurers would use it in contract negotiations with clinics. He said he hopes clinics would embrace any bad results as motivation to improve.

"The worst," he said, "is if you're not doing a good job and you don't know it."

Overall, 78 percent of patients gave their doctors excellent ratings, but there was wide variation. Only 47 percent of patients at Apple Valley Medical Center's urgent care gave top marks to doctors, compared with 93 percent at the Lakewood primary care clinic in Pillager, Minn.

Craig Wolhowe, Lakewood's vice president of clinic and hospital services, credited the clinic's success to doctors who listen to patients and a system that doesn't pay doctors per visit or pressure them to rush through appointments.

"Whether you're choosing a hardware store or grocery store, you pick it based on what? Where you feel the most comfortable and get the best service," he said.

Only 26 clinics scored above average, statistically, in all four categories, although some small clinics had high scores but not enough survey responses to have a statistical margin of error that was above average.

The ratings are based on surveys completed by 230,000 patients in 2012.

Personal touch

Minnesota Community Measurement has graded clinics for some years on "outcome" measures, such as how many of their diabetic patients have controlled their blood sugar and how many of their depressed patients feel better over time. But Chase expects the patient survey data to be popular because it is familiar — like a recommendation by a friend or brother-in-law.

"It is something that they can relate to," he said.

Some clinics with top-rated doctors scored lower on access — presumably because their popularity with patients makes appointments hard to get. Only 64 percent of patients at the highly regarded Pillager clinic said they received an appointment or medical information when they wanted it. The clinic hopes to boost that rating next year by offering patients other providers on days when their usual doctors aren't available, and promising that their doctors will review the results of those visits, Wolhowe said.

Among clinics that scored average or below average in all four measures was the Medical Advanced Pain Specialists, or MAPS, clinic in Edina, which was caught up last fall in a furor over patients who received contaminated spinal injections from an out-of-state compounding pharmacy. Only one-third of MAPS patients reported timely care, and only 60 percent regarded doctors as excellent.

Whether or not the negative publicity played a role in its ratings, MAPS has the challenge of patients in chronic pain or addicted to opioid painkillers who might not be as likely to provide positive feedback, said Christiaan Engstrom, MAPS's chief operating officer. "We have been taking proactive measures to better serve our patients," he said. "We feel the community understands the challenges."

Hiring additional doctors has reduced the wait time for appointments from four weeks out to the same day, he said.

Steve Schwarze of Eagan said he completed a survey this year that won't make MAPS look any better. While he had no trouble getting a first appointment for back pain, he said, he found the clinic unresponsive when he called between appointments seeking a medication refill and when he needed the clinic to contact his insurer to approve a procedure.

"I gave them every chance I could," said Schwarze, who switched to another pain clinic.

Pitfalls

Minnesota has been a leader in rating clinics based on performance criteria. But rating doctors by patient survey responses has caused some unease, in part because doctors sometimes have to make tough decisions that might upset patients, such as declining to give them antibiotics or imaging scans when they aren't necessary. Some have worried that doctors could be swayed to make decisions purely to appease their patients and improve their ratings.

Ehlinger said the breadth of responses means that a clinic's scores won't be influenced too heavily by any one patient. Clinics had to have at least 120 patient responses, for example, for their access scores to be listed.

Clinic results are searchable by specialty, which could be important because patient satisfaction can vary by clinic type. Cancer specialists, for example, tended to receive more positive feedback. Urgent cares such as the Apple Valley clinic scored lower on patient surveys, probably because the patients have no prior relationship with the doctors. The three lowest-rated clinics for physician quality were all urgent cares.

All clinics are now expected to collect and provide their survey data. Most hire survey companies at a minimum cost of $1,200 per year. Clinics not listed this year included those with too few patients to provide reliable data and pediatric clinics, which will be evaluated separately.

Jeremy Olson • 612-673-7744