Becker's Hospital Review

CARE DELIVERY 87 e surgeons confirm that the score- card has garnered attention within the medical community, as Mr. Allen guessed. ProPublica's reporters in New York City continue to receive emails about the da- tabase, but Mr. Allen says they have not received as many as one might think. "We just published 17,000 complication rates and we've gotten maybe fiy-ish emails — that's from patients, hospitals, that's every- body. In a way that's not a lot of response." Based on the emails he has received — many from physicians and researchers with questions, concerns and corrections — he guessed most of the scorecard's web traffic so far stems from the medical com- munity. Despite this attention, the Surgeon Scorecard hasn't changed how hospitals are addressing their lowest performers, based on interviews with physicians. A month and a half aer its publication, none of the surgeons' affiliated hospitals had taken action directly in response to the tool. Drs. Cooper, Kudrna and Crutch- er each confirmed that the data has not yet influenced changes within their current clinical quality improvement programs, which are already focused on continuous improvement. Dr. Cooper of the Palo Alto Medi- cal Foundation, part of Sacramento, Ca- lif.-based Sutter Health, said, "None of our doctors have a score they need to feel bad about." Dr. Crutcher of Orthopedic Physician Associates in Seattle made a similar confir- mation. "It's not something that regularly occurs, where a doctor has a high com- plication rate in one area. We all operate with the same care processes and measures so we maintain a standard level of perfor- mance," he said. Dr. Crutcher is included under Swed- ish Medical Center's Medicare ID, which does not have any hip replacement sur- geons in the "red" zone with high rates of adjusted complications. Almost all of its hip replacement surgeons span the tool's medium range of complications, which means the surgeons' patients fared no bet- ter or worse than their peers' patients. A medium rate can also mean there is not enough data to put the physician defini- tively in the low or high range. However, not all Swedish Medical Center surgeons are operating outside of the "red" zone. A couple of knee replace- ment surgeons in particular fall into the area for high adjusted rates of complica- tions. is is not unique to Swedish Medical Center — a quick search for Evanston Hos- pital, the Medicare ID for the four-hospi- tal NorthShore University HealthSystem where Dr. Kudrna works, also produces a range of results. Its surgeons span the scale of low to high adjusted rates of complica- tions, with several surgeons in the red zone for various procedures. If anything, the Surgeon Scorecard illuminates that wide variation still exists among surgeons, even at the same facil- ities, and even when clinical quality pro- grams are in place. Doctor's orders While the data may not be changing clinical quality agendas yet, it is fairly rev- olutionary for patients. It helps inform their decision-making and makes it eas- ier to differentiate clinical quality from amenities and customer service. ough ProPublica recently partnered with Yelp to beef up its review pages with CMS data, many reviews authored by patients on Yelp's site, or similar sites like ZocDoc, focus on bedside manner, wait times and other qualitative factors. ProPublica published a response from a reader who was married to a nursing su- pervisor at a local hospital. He said his wife was not aware of the Surgeon Scorecard. "When my mother required gallblad- der surgery, my wife specifically ensured that a certain surgeon wasn't on call for the procedure," he wrote, according to Pro- Publica. "While I was at the hospital visit- ing my wife, I mentioned casually to two of her coworkers (separately) that my mother was upstairs awaiting surgery. Both nurses asked cautiously who was on call and when they found out it was Dr. [redacted] ... they breathed a sigh of relief." e Scorecard helps patients without a connection to a nursing supervisor or indi- vidual with inside knowledge get that same information. Studies show a thirst for this information, too. In a 2015 survey of more than 3,000 consumers, the National Re- search Corp. found 70 percent of consum- ers are interested in seeing performance data before choosing a healthcare provider and 45 percent have viewed physician rat- ings or reviews online. Almost a third said they looked at online ratings or reviews as a first step in finding a physician. at said, none of the physicians we talked to had heard a patient mention the Surgeon Scorecard. is may be because it is still too new, or patients say they found a physician "online" with no further speci- fication, or use it alongside other methods, such as word-of-mouth or physician refer- ral. "In my experience, the most common referral source is other patients. You have a patient that has a good outcome and they become a megaphone," Dr. Crutcher said. "Way down the line are online rating sys- tems. I've heard from others before: Peo- ple value referrals from friends, family and primary care physicians much more than an Internet source." With 40 years of experience and an estimated 19,000 hip replacements under his belt, Dr. Kudrna confirmed word-of- mouth was also the top way his patients found him. For younger physicians, he guessed physician referrals were king. "Many of those types of referrals are based on success of patients. As [your career] builds it's a patient referral, but earlier on, it's physician referral." While personal and professional refer- rals may be the norm for the Drs. Crutch- er and Kudrna, who are already ranked among the nation's top surgeons for Medi- care hip replacements, established online tools are increasingly factoring into patient decisions. According to the National Research Corp. survey, 60 percent of consumers feel online ratings and reviews are important when choosing a new physician, especially when it's on a "site which I recognize and trust." Based on this data, the Scorecard has the potential, with time, to become very influential. Making the grade It may still be too early to see if the Surgeon Scorecard will make a difference in healthcare. e utility of the tool for consumers hinges on how patients define

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