Physician-rating game fraught with difficulty.(Practice Trends)

WASHINGTON -- The lists of "best doctors" published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

"Outcomes are much more difficult to measure in health care" than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine "Consumers' Checkbook" in several cities nationwide. "Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out."

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. "Patients would report their experience with physicians--they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors," he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

"The health care system is pitiful when it comes to public information," said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. "As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where ...