Surgeon Scorecard

SS
I was recently alerted to this newly released project from ProPublica. Surgeon Scorecard provides a numerical rating of surgical complications by individual surgeons, hospitals, regions, or states. Based on Medicare billing data about eight elective procedures from 2009 through 2013  ProPublica suggests you “(u)se this database to know more about a surgeon before your operation”.

ProPublica founded in 2007 “is an independent, non-profit newsroom that produces investigative journalism in the public interest“. See more at https://www.propublica.org/about/

The creation of Surgeon Scorecard was “(g)uided by experts, ProPublica calculated death and complication rates for surgeons performing one of eight elective procedures in Medicare, carefully adjusting for differences in patient health, age and hospital quality.” See https://projects.propublica.org/surgeons for more information.

The eight procedures included in the analysis:PP table

 

The project analyzed Medicare billing records of >16,000 surgeons and >2.3 million procedures and did not include data about patients with private insurance.

More about methodology:

“Because there are many ways to define a surgical complication, we consulted with two dozen physicians to identify those that are directly related to each of the operations. These include infections, blood clots, misaligned orthopedic devices and uncontrolled bleeding. We then counted only cases in which the patient died in the hospital or had a complication requiring readmission within 30 days.” The article from which this quote is taken can be read in its entirety at https://www.propublica.org/article/surgery-risks-patient-safety-surgeon-matters. This is a link to a PDF of a longer, more technical methodology statement.

The database interface can be found at https://projects.propublica.org/surgeons/. You can search by surgeon, by hospital, by hospitals in your area, or state. See below of for an example of a report about “Some Hospital”. Each small black vertical line is one surgeon, and stop light colors are used to indicate low, medium and high complication rates.

Some hosp

A piece in  Forbes written by a urologic surgeon raises questions. The post in KevinMD provides more commentary: http://www.kevinmd.com/blog/2015/07/why-the-surgeon-scorecard-is-a-journalistic-low-point-for-propublica.html.

Many of us find ourselves somewhat voyeuristically checking the records for our state, hospital, or favorite surgeons to see what those numbers look like. After the initial “thrill”, I am left with many more questions than answers. Will patients make decisions about which surgeon based on this information? l public scrutiny improve outcomes? Are we looking at the right outcomes? Are re-admissions the right measure? Is it right to assign all responsibility for death or early readmission to the surgeon? Does the methodology truly adjust for complex patients or for lower performing hospitals. Are the case numbers large enough for each surgeon/procedure to base decisions on? Many of the individual surgeon records I looked at had case numbers in the 20s over a 5 year period. Surgeons with “bad numbers” do not seem to have any recourse. Now labelled, they cannot realistically receive deeper analysis of their numbers by an impartial body as that would require individual chart review by independent physician reviewers. The associated medicolegal, confidentiality, cost and time challenges are overwhelming. Is Surgeon Scorecard a public service or ProPublica advertisement?

At the least, this Scorecard will provoke conversation as we move forward in this world of increased transparency of physician practice. At the worst it has the potential to injure the reputation and careers of good surgeons improperly identified by superficial statistics.

–Whit

 

 

About Whit

Whit is the Education and Information Consultant for Medicine at UCSF Library.
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