ProPublica on Tuesday released a scorecard of risk-adjusted complication rates for almost 17,000 individual surgeons at more than 3,500 hospitals nationwide based on an analysis of Medicare data.
The scorecard categorizes the adjusted complication rates by surgeon as low, medium, and high. It allows users to search by location, by surgeon, or by hospital.
For its analysis, ProPublica analyzed Medicare data from 2009 to 2013 for eight common elective procedures, which accounted for 2.3 million total surgeries:
- Knee replacements;
- Hip replacements;
- One type of spinal fusion on the neck;
- Two types of spinal fusions in the lower back;
- Gall bladder removals;
- Prostate removals; and
- Prostate resections.
ProPublica's Marshall Allen and Olga Pierce say they selected those eight procedures because "they are typically performed on healthy patients and are considered relatively low risk."
ProPublica excluded trauma and other high-risk cases from its analysis, excluded surgeries on beneficiaries who were admitted through another health care facility or the ED. The analysis adjusted the complication rates based on the patient age and health, luck, and each hospital's overall performance.
The publication consulted with 24 physicians to determine which hospital readmissions within 30 days that "could be reasonably attributed to complications from surgery." The analysis only counted patient deaths that occurred in the hospital within a beneficiary's initial stay.
ProPublica did not report complication rates for surgeons that performed fewer than 20 operations of a certain type on Medicare beneficiaries.
The analysis found that surgeons' complication rates often varied widely within each hospital.
The overall complication rates across all surgeons ranged from 2% to 4%, depending on surgery type. Overall, about 750 surgeons who performed 50 or more operations did not have any reported complications across the five years studies, while 1,423 had one reported complication.
But 11% of surgeons accounted for about 25% of all complications, and hundreds of doctors had rates that were two or three times the national average, ProPublica found.
Overall, the analysis concluded that complications across the eight surgery types resulted in about:
- 63,000 Medicare beneficiaries suffering serious harm
- 3,400 patient deaths; and
- $645 million in costs to taxpayers for readmissions.
Member asks: How do I structure a physician performance scorecard?
Reaction to analysis
Charles Mick, former president of the North American Spine Society, says the analysis is "long overdue" and will hopefully "be a step toward a culture where transparency and open discussion of mistakes, complications and errors will be the norm and not something that’s hidden."
Harvard School of Public Health professor Thomas Lee, who specializes in patient outcome measurement, says that ProPublica's "methodology was rigorous and conservative."
However, some hospitals and quality experts have pushed back against the findings.
Johns Hopkins Medicine safety expert Peter Pronovost said that the analysis did not take into account that some physicians are more likely to readmit patients to the hospital as a precaution, and criticized the use of readmissions to identify patient complications from surgery. He said it would be "highly irresponsible ... to make an example of any surgeon based on faulty data analysis."
Other hospitals noted that their surgeons see particularly challenging mix of patients, argued that the Medicare data did not provide a statistically robust sample for their doctors, or said the findings could demonstrate errors in data submitted to Medicare (Wei et al., "Surgeon Scorecard," ProPublica, 7/14; Allen/Pierce, ProPublica, 7/13; Allen/Pierce, ProPublica, 7/14; ProPublica, 7/14).
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