Public reporting doesn't improve heart outcomes

When it comes to heart patients, transparency is not always the best policy, according to a study published yesterday in the Journal of the American Medical Association.

States that publicly report percutaneous coronary intervention (PCI) outcomes perform fewer of the procedures, especially for high-risk patients, than states without mandatory public reporting. But in a step back for transparency, the study found no difference in overall mortality between states with and without public reporting.

Harvard School of Public Health researchers analyzed about 100,000 Medicare patients in the reporting states of New York, Massachusetts and Pennsylvania and nonreporting states of Maine, Vermont, New Hampshire, Connecticut, Rhode Island, Maryland and Delaware and found similar 30-day mortality rates among heart patients.

But given the underuse of PCI in reporting states, some physicians worry that public reporting may prevent some of the sickest heart patients from getting care because doctors may want to avoid potential poor outcomes.

"The study highlights the unintended consequences of public reporting," University of Michigan cardiologist Hitinder Gurm told the Los Angeles Times.

However, the study authors point out that public reporting policies may have prompted cardiologists to only perform the most appropriate procedures, Kaiser Health News reported.

While a nonreporting state in the study, Maryland has been taking steps to improve transparency and curb unnecessary heart procedures. In April, the state general assembly passed a bill to mandate independent review of coronary stent placement and whether it is medically necessary. The bill is slated to go to the governor's desk.

While patient safety advocates continue calls for greater transparency of treatment, quality and costs, critics have been questioning the accuracy of public reporting data and whether such initiatives can actually improve the quality of care.

To learn more:
- here's the JAMA abstract
- here's the LA Times article
- read the KHN article