Surgeon Complication Rates Now Posted on the Internet

Information on Physician Performance is Here to Stay

Patient complication rates have been posted on the Internet for almost 17,000 surgeons. This landmark undertaking was achieved by ProPublica, an independent, non-profit newsroom[1].

ProPublica posted their “Surgeon Scorecard” in July. It compares the performance of surgeons for eight common elective procedures, including hip and knee replacements, spinal fusions, gallbladder removals, prostate resections, prostate removals, and cervical fusions.

The power of ProPublica’s site was demonstrated to me this morning when my brother sent me a text message that said, “Kathy (his wife) is having her knee replacement this morning.” I immediately asked for the surgeon’s name and then looked up his stats on ProPublica’s new site. In less than 5 minutes, I had information that would have previously taken hours, if not days, of phone calls to colleagues and professional acquaintances for recommendations and best guesses about who would be best for my sister-in-law to see.

Here’s the information ProPublica’s Surgeon Scorecard had on my sister-in-law’s surgeon.

Propublica Surgeon Scorecard Results

How ProPublica Did It

ProPublica compared the surgeons by examining 2.3 million Medicare records from 2009 to 2013. To be fair to surgeons, ProPublica’s analysis accounted for factors such as patients’ health, age, and hospital quality. They counted “only cases in which the patient died in the hospital or had a complication requiring readmission within 30 days.”

What ProPublica Learned

As would be expected, “the numbers show that stark differences in performance of surgeons are commonplace across America. Although overall complication rates were relatively low, ranging from 2 percent to 4 percent, depending on the type of surgery, experts who reviewed ProPublica’s results say they strongly suggest that the typical surgeon’s rate can and should be significantly lower.”

Additional findings from ProPublica’s analysis included:

  • A small share of doctors, 11 percent, accounted for about 25 percent of the complications.
  • Hundreds of surgeons across the country had rates double and triple the national average.
  • Every day, surgeons with the highest complication rates in (their) analysis are performing operations in hospitals nationwide.
  • Subpar performers work even at academic medical centers that are considered among the nation’s best.

But, Even More Shocking …

Many hospitals don’t track individual surgeons’ complication rates and neither does Medicare or many commercial health plans

Medicare and accreditation organizations simply haven’t required hospitals to track patient death rates and complication rates by doctor. Beyond meeting some minimum standards, hospitals are free to decide how much of this information to collect. Isn’t it time for this to change?

“If you leave it up to altruism of hospitals, you end up with what we have now — just a few that use meaningful data to improve quality,” said Dr. Marty Makary, a surgeon and professor at the Johns Hopkins University School of Medicine.

Even more shocking – every hospital in the country already has the data to comprehensively track complication rates for each physician in their organization. It resides in our finance systems, which I’ve used for the past 20 years to create clinical dashboards for my colleagues.

What You Should Do

I encourage you to review your information on ProPublica’s website. With the information in hand, take the following steps:

  • Compare the complication rates posted by ProPublica with your internal data – surgeon by surgeon. You’ll need to be sure you use the same codes, timeframe, and Medicare population that ProPublica used in their analysis.
  • Present your findings to your executives and your physician leaders. With their guidance, develop a plan of action.
  • Develop action plans for all physicians who have “a high adjusted rate of complications.”

Help Is On The Way

In upcoming posts, I will share more information about complications, their impact on our patients and organizations, and dashboard templates for each of the eight procedures profiled by ProPublica.

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[1] ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest. ProPublica.org