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‘Surgeon Scorecard’ Measures Docs by Complications

Model gets mixed reviews from medical community

Surgeons around the country can now be scored against their peers in a new statistic that goes beyond hospital-level data, providing a tool for consumers and generating debate in the surgical community, according to an article in USA Today.

Nearly 17,000 doctors performing low-risk, common elective procedures, such as gallbladder removal and hip replacements, are measured in the new calculation developed by the nonprofit news outlet ProPublica. The data, derived from government records of Medicare patients,  is now available for anyone to search.

Not all surgeons will be happy seeing their names online with a higher-than-average complication rate based on problems that call for postoperative care, such as infections, clots, or sepsis. But the model also factors various risks a surgeon encounters, and adjusts the complication rates based on patients’ ages, the quality of the hospital in which the surgery took place, and other factors.

ProPublica found that, among Medicare patients, approximately 66,000 cases of complications that led to additional hospitalization cost taxpayers $645 million between 2009 and 2013. The analysis also identified at least 3,400 people who died in hospitals after being admitted for one of the reviewed elective surgeries (heart valve and bypass surgery, total knee and hip replacement, or gastric, hernia, or spine-fusion surgery).

Last year, the Centers for Medicare & Medicaid Services began docking payments at hospitals that had excessive readmissions in an effort to improve care. But the first-of-its-kind analysis by ProPublica found substantial variation within hospitals. Half of the 3,575 hospitals had surgeons performing procedures that put patients at high risk.

So why do doctors, even when surrounded by the same staff and high-tech equipment, have different scores?

ProPublica’s analysis and past medical research suggest that complications can depend on four factors: genuine surgical skill; a strict adherence to best practices with procedures; the volume of surgeries; and direct follow-up with personal contact. The analysis also found an overall low rate of readmission and death across the country — less than 5% for the procedures studied.

The model was introduced on July 12 to mixed reviews from the medical community, with some physicians skeptical that it could capture the array of risks involved with different patient populations.

Dr. Jen Gunter, an obstetrician/gynecologist in San Francisco, wrote on her blog that the model could lead to doctors choosing lower-risk patients to boost their scores.

“What if every surgeon operated only on the good candidates?” Gunter wrote. “People at higher risk for complications will suffer, and we will never get surgeons with superior skills.”

But Dr. Charles Mick, a spine surgeon in Massachusetts who advised on the project, said the new statistic should be viewed by physicians and hospitals as another tool to improve care.

“I'm hopeful hospitals will look at the data and look for other systems that could work for them,” Mick said. “And if you’re below average, you can demonstrate how they’ve improved.”

Sources: USA Today; July 14, 2015; and Surgeon Scorecard; 2015.


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