Public reporting of physician data: a good idea implemented badly

I know I'm going to take heat from my colleagues on this one, but try to bear with me a bit as I explain my position.

With very rare exception we adhere to the idea of delivering high quality medicine.  We would each be willing and proud to report openly our results IF we had measures we could trust and a process we could follow without further eroding the care we deliver to our patients.  The problem at the moment is that we have neither.  We have external bodies using the data they have (e.g. insurance claims) that are highly prone to error, and a process that lays a very significant uncompensated work burden on us when we're struggling just to keep our heads above water.

One of the problems we face in the current paradigm of measurement approach is that we're held responsible for factors mostly outside our control. 

Using the Evans and Stoddard model as a framework, health and wellness is a result of the interaction between the following:

As a physician I have the most control over the delivery of health care.  I have the ability to recommend and advise a patient regarding their disease.  I can offer advice on physical & social environment, note the effect of prosperity, cheer on helpful behavior.  All of this I can and should do, yet I recognize the limitations of my intervention in the face of a society that allows income to determine health access & outcome.  How much impact can I have on diet when Congress supports the worst of diets with agriculture subsidy to huge business conglomerates? 

Judge me and my practice not on the complex and messy data but on how my office works as a system.  Office practices are high performing when they eliminate waits & delays, provide superb communication, solve the access problem for their patients, support their patients so that the patients report high confidence in management.

All of these factors can be measured through the aggregate experience of patients served in the practice - thus allowing statistically meaningful analysis even to the level of the individual physician.

Horizon BCBS of NJ has implemented a program of publicly reporting physician performance.  It is probably using claims data and a member satisfaction survey.  If so, this is the wrong data set.  For all we know they're judging practices based on increasing the rates of mammography between 40-50 and prostate cancer screening in men - both highly controversial and thus bad measures of 'quality.'

Horizon BCBS of NJ allows physicians to request the data and on their own time perform a laborious chart review.  If the physician responds in time the insurer will allow changes to the report card.  This unfunded mandate is a crushing burden to practices.  The physician responses I've read on line to this initiative:

• "just send all complex sick patients to the ER and get them out of your practice - you'll be burned by their bad outcomes."
• "what time do we have left for our families after appeasing the gods of managed care???
  enough!!!!"
• "This  is extremely alarming"

These are good doctors being crushed by policies that look good on paper but fail the front line test of reasonableness.  As I said at the start: I am in favor of public reporting, but the data must be valid and the process reasonable.  This initiative appears to fail on both.