- Contents of 2 vast databases of surgeon outcomes data released to the public.
- Information is intended to support performance-based medicine by enabling patients to search for surgeon with lowest complication rates.
- SurgeonRatings.org and Surgeon Scorecard published data largely with surgeons’ cooperation.
- Significant variations found in complication rates among surgeons.
- Surgical complications found to vary more between surgeons than among hospitals.
What Is Being Disclosed?
An extensive analysis of more than 16,000 surgeons by Propublica.org has revealed stunning variation in complication rates among surgeons. For common elective procedures, the report, called Surgeon Scorecard, found complication rates among surgeons to vary wildly.
The purpose of the data release is to empower patients as informed healthcare consumers, and to force clinicians to practice performance-based medicine, to continually work to improve outcomes.
When a surgeon improves her outcomes versus competing peers, her income likely increases as well, as will her patient-satisfaction scores, and, as a result, her quality of life improves — and the revolution begins.
The synergy between intelligent healthcare consumers and physicians who practice performance-based medicine, if widely applied, could bring another great systematic revolution to the practice of Western medicine.
The Propublica.org team evaluated nearly 17,000 surgeons based on the results of 8 of the most common elective procedures in Medicare data during the period 2009 to 2013. This database includes patient-generated data. On Surgeon Scorecard, patients can search by specific location, state, hospital, or surgeon name, and both read and write reviews, and view clinical data, such as complication rate, on surgeons in an area.
This is the crude beginning of patients being able to become intelligent consumers, and to find the best value in their caretakers. Patients can find out who will offer the best outcome. The lowest cost? The best patient experience? The answers to these questions will increasingly drive patient choices of caretakers. This shift will significantly alter income patterns among both generalists and specialists.
SurgeonRatings.org is a database of information on more than 50,000 surgeons in the U.S. containing Medicare data published between 2009 and 2012 as well as patient evaluations. Physicians can be ranked by patients using this tool as well. The patient can enter a ZIP code, and then a surgical procedure from a list of 14 choices. These include gastric surgery, hip, or knee replacement surgery, prostate removal surgery, and spinal cord exploration, according to a report on CNN.com.
Excluded were trauma and high-risk patients based on adjustments for age, patient health, and overall hospital performance, for instance. Then with the help of 24 physicians, the Surgeon Scorecard team reviewed patients who were readmitted to the hospital within 30 days of surgery and judged whether the readmission was related to the operation. If a patient's case made it through all of these filters, then it was considered a complication.
What to Do
For surgeons, this is reason to take a look at the data. Look up your own name here or here and find out where you rank relative to your peers. What is the level of risk associated with your surgeries?
In these terms, of course, your peers are now your business competitors.
The sites — SurgeonRatings.org and Surgeon Scorecard — organize Medicare fee-for-service data into searchable databases for the benefit of patients as healthcare consumers, according to the Center for the Study of Services and Consumers' Checkbook, the organization behind SurgeonRatings.org.
This consumer advocacy group launched the open-access website SurgeonRatings.org in order to give the public greater access to detailed government patient records on post-surgical outcomes. The group behind Consumers’ Checkbook said the site was created after a 10-year campaign to convince the government to release Medicare records to the public, according to a report by CBSNews.com.
Is It Accurate?
Of course it is clear that this are opportunities for anomalies with this sort of statistical approach. There is a great deal of opportunity for inaccurate rankings if only 14 procedures are included, or just 8 in the ProPublica.org analysis. Really, however, if the rankings are bad, you’ve still got a problem. It doesn’t matter why they’re bad. In any case, you’ve got to address the negative PR.
In some cases it is worth hiring a professional firm that manages internet sentiment and user perception. One is www.reputation.com. According to Wikipedia, “The company's products and services are designed to help businesses and individuals monitor, manage, and improve the way they appear online, across search engines, online reviews, and social media.”
An internet search quickly reveals hundreds of internet reputation management and defense firms. It seems as though it could be potentially difficult to find a very good or excellent firm among the many choices. We suggest first consulting with a trusted colleague or friend who has experience with one of the firms on your list. It seems like an area in which anyone who is not particularly internet savvy could easily be swindled. Do as much research as possible before choosing a firm and ask for regular -- daily or weekly -- activity and progress reports.
The Center for the Study of Services has since been chosen among the first vendors to receive Centers for Medicare and Medicaid Services (CMS) approval to conduct Physician Quality Reporting (PQRS) and Consumer Assessment of Healthcare Providers (CAHPS) surveys. The team behind SurgeonRatings.org worked with doctors and statistician consultants to carefully judge surgeons based on several complex criteria including death rates, adjustment for pre-existing patient conditions, and evaluations by other doctors.
"We thought we would find good and bad hospitals,” noted Marshall Allen, a reporter for ProPublica. “What we actually found was a quite a bit of variation between surgeons within the same hospital," explained Mr. Allen.
The findings demonstrate how important it is for surgeons to know where they are ranked and why. If the rankings are unrealistically or unreasonably negative, it’s likely worth your money to try to change that perception. If you can show that the published numbers are wrong, do so.
The reason that surgeons should be knowledgeable of and in control of their own public rankings is simple: patients will increasingly learn to shop among surgeons. In a place like New York City, or Cleveland, Ohio, or Los Angeles, San Francisco/The Bay Area, Boston, Fort Lauderdale, Fla., or Rochester, Minn., among many others, Patients have the choice among a large number of skilled surgeons. The competition among surgeons could become very intense if patients were truly able to shop freely and intelligently among physicians.
What Else to Do
For a surgeon who finds him or herself ranked low and the ranking is accurate, there are still a number of choices. First, identify the primary cause of the complications and address that through a change in your technique, your instrumentation, or through further professional training. Talk to one of your partners about his or her technique. Everyone has an interest in you being able to lower your complication rate. You are certain to be able to learn from a colleague.