What impact has the ‘Surgeon Scorecard’ had on your practice?

Dr. Renzulli“It’s interesting because I’ve done over 1,000 prostatectomies, but when I looked at my numbers, it only cited 20-some cases. So if the volume doesn’t seem to be accurate, my main concern would be whether the rest of the information on complication rates is actually accurate.

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The volume of prostatectomies is down, but there are fewer urologists doing the procedure so many cases are funneled to me, and my personal volume has maintained the status quo.

No one asks me about the Scorecard specifically, but I can tell you if people go online, see something, and have questions, often they will take that to their referring physician-their urologist or their primary care. Most of these inaccuracies I find on the Internet are debunked by the practitioner who knows my reputation or my outcomes based on their other patients who have been through my office. That usually suffices in giving patients confidence that what they saw was not necessarily accurate. So I’ve found the Scorecard not to be of any consequence.

It does bother me that it might not be reflective of the true complications or volume, because they’re actually putting out inaccurate information.”

Joseph Renzulli, II, MD

Providence, RI

Next: "I haven't felt any impact"

Dr. Bivins“I haven’t felt any impact from the Surgeon Scorecard. There are various ratings from Medicare or insurance companies or surveys, but never have I had a patient go on a Centers for Medicare & Medicaid Services site, or other sites, to check out complication rates.

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That information should be submitted to CMS and as chairman of surgery at our hospital, as we’re looking at credentialing and re-credentialing, we look at complication rates. But even for us, the problems are: One, are all complications reported? And two, the definition of complication is not standardized. You can have a pimple or a full-blown infection, and they are simply reported as complications. What’s a readmission? Are patients re-admitted because they’re sick and septic, or are they just being readmitted because the hospital doesn't have an observation unit, which isn't considered an official readmission for assessing complication rates?

If the patient is admitted to an observation unit, that’s not a re-admission.

The problem is standardization. That’s the huge problem I’ve run into. We get raw data, but we’ve got to really dig into it to make it applicable. The same problems occur with the patient information sites.

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The other problem is, if one doctor does not submit the same complications as another, the statistics are going to be skewed. It’s hard to make sense of it, but patients will be looking at it, so it’s something we’re going to need to be aware of.”

V. Michael Bivins, MD

Homewood, AL

Next: "We’re trying to compare surgeons whose practices are completely different."

Dr. Garzotto“People, in general, put a lot of weight on numbers. I’ve looked at ProPublica’s methodology. We do a lot of research, and methodology is very important. It’s easy to misinterpret results you see online. The database ProPublica used doesn’t have the information to account for all the factors that are important if you’re going to compare surgeon to surgeon. They didn’t have data on comorbidity or extent of disease. They were limited in terms of the quantity and the quality of information that can be extracted from the Medicare database. It’s easy for the public to go to that site and walk away with either a positive or negative impression that isn’t based on scientific research.

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If doctors are willing to do heavier patients, patients with diabetes, or patients with more advanced disease, their complication rate is going to be higher. Patient selection is a strong factor, and it’s part of our medical system. I’m concerned some doctors might decide not to do the heavier or sicker patient because it could skew their complication rates.

I’ve talked to patients who say they’ve chosen a surgeon based on the ProPublica Scorecard. Patients are much more technologically savvy; they think the answer to all their questions can be found online somewhere. But with surgeon quality, we don’t have the metrics. We’re trying to compare surgeons whose practices are completely different. We’re comparing apples to oranges. Patients don’t understand that. They think because it’s published on a reputable site that it’s the final word on the quality of the surgeon. Patients will be misled.”

Mark Garzotto, MD

Portland, OR

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