The holy grail for bean counters who focus on healthcare quality are tools for patients to help them find the best doctors. The argument goes: transparency will help drive quality initiatives; the data will help patients find the better doctors.
The process took off in 1986 when the Health Care Financing Administration released report cards of hospital-specific, risk-adjusted mortality rates for coronary artery bypass surgery. In 1991, New York picked up the baton by releasing stats for individual surgeons for risk-adjusted mortality rates for coronary artery bypass surgery. So, this data has been around for over two decades.
David Brown, et al. researched whether this data influenced referral patterns of cardiologists to specific cardiac surgeons. Their finding were published in Circulation, November 2013: Influence of Cardiac Surgeon Report Cards on Patient Referral by Cardiologists in New York State After 20 Years of Public Reporting
The findings:
- Awareness of the cardiac surgery report card was nearly universal among cardiologists (94%)
- Only 25% of cardiologists reported the report card had a moderate or substantial influence on referral decisions.
- The report card was not discussed with any patients by 71% of the cardiologists.
- Only 34% of cardiologists reported that the quality of the cardiac surgeon to whom they most commonly refer was among the best available.
- 60% of cardiologists reported they would send their family members to the cardiac surgeon to whom they refer most of their patients.
What does this mean?
It means that the decision to refer does not always distil to a single variable – even if that variable is mortality. The respondents stated that the report cards had limitations. Of those who stated there were significant limitations,
- 59% stated there important factors other than mortality were missing from the report cards.
- 53% stated risk-adjustment methods are inadequate to compare surgeons.
To the cardiologists, perhaps referral to a good surgeon was adequate – even if “not the best.” Further, for some patients, geography matters. Does it make more sense to the patient to receive care locally or be referred to a tertiary care facility 100 miles away? What about insurance restrictions – in-network versus out-of-network?
The study highlights that risk-adjusted mortality rate for CAB is important. But, a referral takes into account many other factors. At one time we had minimal data. Now, we have more data. The questions being asked are: Are the data clean? Are the data relevant? Are the data being used?
No easy answers – except that some medical report cards do not seem to influence referral patterns or patient decisions.
The process took off in 1986 when the Health Care Financing Administration released report cards of hospital-specific, risk-adjusted mortality rates for coronary artery bypass surgery. In 1991, New York picked up the baton by releasing stats for individual surgeons for risk-adjusted mortality rates for coronary artery bypass surgery. So, this data has been around for over two decades.
David Brown, et al. researched whether this data influenced referral patterns of cardiologists to specific cardiac surgeons. Their finding were published in Circulation, November 2013: Influence of Cardiac Surgeon Report Cards on Patient Referral by Cardiologists in New York State After 20 Years of Public Reporting
The findings:
- Awareness of the cardiac surgery report card was nearly universal among cardiologists (94%)
- Only 25% of cardiologists reported the report card had a moderate or substantial influence on referral decisions.
- The report card was not discussed with any patients by 71% of the cardiologists.
- Only 34% of cardiologists reported that the quality of the cardiac surgeon to whom they most commonly refer was among the best available.
- 60% of cardiologists reported they would send their family members to the cardiac surgeon to whom they refer most of their patients.
What does this mean?
It means that the decision to refer does not always distil to a single variable – even if that variable is mortality. The respondents stated that the report cards had limitations. Of those who stated there were significant limitations,
- 59% stated there important factors other than mortality were missing from the report cards.
- 53% stated risk-adjustment methods are inadequate to compare surgeons.
To the cardiologists, perhaps referral to a good surgeon was adequate – even if “not the best.” Further, for some patients, geography matters. Does it make more sense to the patient to receive care locally or be referred to a tertiary care facility 100 miles away? What about insurance restrictions – in-network versus out-of-network?
The study highlights that risk-adjusted mortality rate for CAB is important. But, a referral takes into account many other factors. At one time we had minimal data. Now, we have more data. The questions being asked are: Are the data clean? Are the data relevant? Are the data being used?
No easy answers – except that some medical report cards do not seem to influence referral patterns or patient decisions.
