New sites allow patients to compare surgeons based on outcomes, complication rates

Two new sites launched today will allow consumers to evaluate and compare surgeons based on never-before-available information on complications rates and patient outcomes.

The first, www.surgeonratings.org, released by the nonprofit Consumers' Checkbook/Center for the Study of Services, only lists surgeons that have had better-than-average outcomes based on an analysis of more than four million surgeries conducted by 50,000 surgeons on hospital inpatients.

The ratings, which don't include poor performers, take into account how often the surgeon's patients die in the hospital or within 90 days of discharge, have serious complications in the hospital or are readmitted to the hospital within 90 days of discharge.

The site allows consumers to search by ZIP code for the top-peforming surgeons in 14 high-risk surgeries, including heart valve and bypass surgery and total knee and hip replacement. Ratings are based on federal government records previously not available to the public, the organization announced.

"This is the first time we're doing this and it's going to catch people by surprise," said Robert Krughoff, Checkbook's president, in the announcement. "So we chose this time to focus on the good ones and to tell people who they are."

But the second website, Surgeon Scorecard by ProPublica, does include surgeons that have higher-than-average complications based on infections, clots or infections that call for post-operative care.

The non-profit news outlet calculated death and complication rates for surgeons who perform one of eight elective procedures in Medicare, including gall bladder removal and hip replacements, adjusting for differences in patient health, age and hospital quality.

In an editor's note, Stephen Engelberg said that the publication decided a year ago to publicly compare the performance of surgeons because consumers didn't have access to the information.

"These days, consumers can review ratings on everything from plumbers to hair salons to the latest digital cameras," he said. "The process of undergoing surgery includes some of the most consequential decisions any of us ever make. So we began with the view that the taxpayers who pay the costs of Medicare should be able to use its data to make the best possible decisions about their healthcare."

The news outlet consulted with patient safety leaders and hired a biostatics professor from the Harvard School of Public Health to develop a methodology it aims to be useful to patients and fair to surgeons. It focused on non-emergency operations scheduled in advance and generally performed on patients who are in stable health.

To be fair to surgeons, Engelberg said the publication excluded patients who came in through the emergency room or were transferred to the hospital from another facility. Comparisons of performance are based on deaths while in the hospital and readmissions that were the likely result of a post-operative complication within 30 days.

Ultimately, Engelberg said, the publication hopes the information will lead to a reduction in preventable medical errors, by spurring accountability for breakdowns in patient care. The tool is already generating feedback in the patient safety community.

"I would be surprised if any experienced clinician challenged the basic finding, which is that there is real variation among surgeons," wrote Thomas Lee, M.D.  "A critical step toward improving care is to recognize that there are opportunities to improve. I think transparency on quality is a powerful tool, and, frankly, I prefer that to financial incentives as a way to drive competition and improvement on quality."

But Peter Pronovost, M.D., senior vice president for patient safety and quality, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore, said the ProPublica measure isn't valid. He claims that the method should include all patients who face the same probability of being readmitted. In addition, he said that the model should be tested and validated before presenting it as a tool that consumers can use for medical decision-making.

And in her blog, Jennifer Gunter, M.D., wrote that the tool may actually backfire because it doesn't take into account that many surgeons operate on high-risk patients who still need surgery. She worries that the model may lead to surgeons choosing to operate on lower-risk patients so they can improve their scores. "What if every surgeon only operated on the good candidates?" she wrote. "People at higher risk for complications will suffer and we will never get surgeons with superior skills."

To learn more:
- here's the SurgeonRatings site
- here's the announcement
- check out ProPublica's site
- read the ProPublica's editor note
- here's the feedback on the site
- see the list of experts consulted (.pdf)
- check out Gunter's blog post

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