On September 7, 2010, Consumer’s Union (publisher of Consumer Reports) reported the results of coronary-artery bypass graft (CABG) procedures at 221 surgery programs (about 20% of U.S. programs). Matched with a Perspective article in the September 9, 2010 issue of the New England Journal of Medicine online, which described this voluntary reporting as a “watershed event;” thus having enormous implications for hospital CV programs. The data derive from the Society of Thoracic Surgeons (STS) database used by 90% (1,100) U.S. cardiac surgery programs. Each volunteering program is now rated one, two or three stars based on an analysis of eleven performance measures endorsed by the National Quality Forum (see the article for a complete listing of outcome measures – they should be familiar to everyone). The ratings depend upon whether the risk-adjusted outcomes in a program fall below, are equal to, or exceed the average performance range.
STS data has historically been closely held by its participating hospitals and surgeons. This effort on their part to make it transparent will be widely debated. The ratings have their shortcomings. They are voluntary, and typically only those with good ratings have released the information (50 programs that received three stars released data while only 5 with one star released their information). This effort begs real questions of how valid such rating systems are in helping consumers choose between competing programs, and whether voluntary or mandatory systems are optimal. However, the mounting consumer (and governmental) pressure for transparency was instrumental in bringing this rating system to completion. The oft heard complaint of physicians, that such data is not valid, is countered with the voluntary release of data from participating physicians themselves under the imprimatur of their own professional society (the STS) which has been highly rigorous in testing its validity.
The authors conclude with the following comments:
- Regardless of the approach taken to transparency (voluntary or mandatory), public reporting will increasingly be a fact of life for physicians.
- The approach taken by the STS can be applied to other initiatives aimed at bringing performance data derived from clinical sources to the public (and thereby reducing the time and expense involved). Other professional groups (e.g., vascular surgeons) are surely next.
- This experience may contain lessons for the Center for Medicare and Medicaid Studies as it prepares to handle the sea of new clinical data mandated under programs such as the Physician Quality Reporting Initiative and the “meaningful use” requirements for electronic health records.
CFA strongly concurs with the first bullet – public reporting is here and will increasingly be a part of every hospital and cardiovascular physician groups’ daily lives. CFA’s earlier blog posting – The Best Measure of Outcome is Outcome – published on our website Thursday, March 18, offered recommendations for dealing with Volume/Outcome issues that are generally applicable to the CABG data as well.
CFA refers you to www.nejm.org for the Perspective article: Public Release of Clinical Outcomes Data – Online CABG Report Card – which is a free download. Additionally, the 50 Top Rated Surgical Groups in the U.S. was published in Consumer Reports, October 2010 issue. The complete ratings are available at http://www.consumerreports.org/health/doctors-hospitals/heart-surgeons.htm (although the actual scoring can be reviewed by website subscribers only).
What do you think? As always, CFA invites your comments, suggestions and questions.