Do you know what your 'surgeon score' is?

Robert A. Dowling, MDThere are many perspectives today on the quality of health care that can potentially impact the practice of specialty medicine, including urology. Health policy perspective is driven largely by the public interest in safe, equitable, effective, and affordable care. Insurance companies’ perspective is informed by value: the relationship between quality and cost. Physicians’ perspective is guided by adherence to best practices but adjusted for the “art” of medicine. Patients’ perspective on quality is largely related to outcomes-their health state and satisfaction.  

Read: CMS data offer insights into urologists’ pay

A new public perspective on quality is emerging. Online rating sites, social media, and analysis of public datasets have begun to shape a larger perspective on quality, including the quality of health care institutions and providers. In this article, I will examine one of the latest examples-the “Surgeon Scorecard.”

ProPublica is an investigative journalism company whose self-described mission is “to expose abuses of power and betrayals of the public trust by government, business, and other institutions, using the moral force of investigative journalism to spur reform through the sustained spotlighting of wrongdoing.” ProPublica first gained notoriety publishing “Dollars for Docs” (a searchable list of industry payments to physicians), before the Centers for Medicare & Medicaid Services’ “Open Payments” data became more widely accessible.

NEXT: Two urologic procedures evaluated

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Two urologic procedures evaluated

The “Surgeon Scorecard” is ProPublica’s most recent exercise in using publicly available datasets to perform analysis “in the public interest.” In the end, the organization has created a search engine for consumers to compare physicians’ complication rates across eight elective procedures based on Medicare inpatient data from 2009-2013 (table). Two urologic procedures are included: transurethral resection of the prostate and radical prostatectomy.

To its credit, ProPublica has made available the detailed methodology for calculating readmission, complication, and death rates. While the focus on elective procedures was intended to select “otherwise healthy patients,” the authors undertook additional steps to eliminate high-risk patients from the data and risk-adjust the remaining patients to create a “fair comparison.” They sought consultation with surgical specialists and have listed the diagnoses leading to procedural admission as well as the diagnoses most likely to represent complications related to the original procedure.

They outlined their method for finding the index admission/procedure. Finally, they published their measure calculation methods.

Detailed findings of the research study that led to search engine access to this database are also available on the ProPublica website (www.propublica.org). The authors found the aggregate rate of readmissions due to complications was under 5%. In addition, 3.1% of patients undergoing radical prostatectomy and 4.2% of patients undergoing TURP experienced a complication. The top three complications after radical prostatectomy were digestive system complications, infection, and pulmonary embolism.

There was wide variation between surgeons, and within but not between hospitals (no “good” and no “bad” hospitals were seen). “Best” surgeons had complication rates about 50% less than “average” surgeons across all eight elective procedures, and there is no further breakdown by procedure. “Worst” surgeons had complication rates three times the average. The authors conclude: “There is substantial variation between surgeons in the rates of harm their patients suffer resulting from surgery, which cannot be attributed to patients' health, or differences in hospital overall performance.”

NEXT: Dataset comes with limitations

Dataset comes with limitations

The data, study, and the results that drive the search engine have important limitations. The most significant issue is that this is derived from inpatient data only, and does not include the patients who undergo the exact same procedure as an outpatient. Also, the data are limited to Medicare fee-for-service patients. For these reasons, the complication rates are probably based on a subset of the surgeon’s patient population. Finally, the analysis and results are subject to the inherent vagaries of administrative data, including differences in rigor and accuracy of coding personnel.

Bottom line: Public datasets and activist journalism are part of a changing public perspective on quality in health care. Patients can now search the “Surgeon Scorecard” for one site’s interpretation of that data relating to complications after some surgical procedures. Urologists would be advised to search for their scores on this and other sites, and understand the opinion that others are shaping about their complication rates.

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