Becker's Hospital Review

CARE DELIVERY 84 Operating in the Public Eye: Life After the Surgeon Scorecard By Emily Rappleye A database released in July argu- ably changed the dynamics of the surgical profession. When the performance of more than 16,000 surgeons became easily searchable online, surgery was suddenly a public-facing profession. e Surgeon Scorecard belongs to nonprofit investigative newsroom Pro- Publica, which has worked on a number of medical transparency projects, in- cluding a recent push to add CMS data to Yelp's review pages. e scorecard is unique among online ratings in that it shines a spotlight on the individual sur- geon's outcomes, rather than those of the hospital. For some surgeons, that light is unforgiving. About a month and a half aer the Surgeon Scorecard's launch, it has been viewed more than 1.7 million times and gained skeptics and supporters alike. Critics call it flawed; some even consider it public shaming. Advocates see it as a stride for patient safety and transparency. Its makers acknowledge the scorecard has some limitations, like any study, but say this doesn't overshadow its impor- tance. "You are going to take some heat if you do it," said Marshall Allen, one of the ProPublica reporters behind the Surgeon Scorecard. "But it prompts the medical community to provide more information to patients, and I think there is a hunger for it. Traffic on the database online has been a big affirmation." However, even with the page views and the outpouring of reaction, it's still hard to pin down the repercussions of this newly available information. We set out to see how life has or hasn't changed for surgeons. Responsible, not at fault A group of ProPublica's investigative reporters created Surgeon Scorecard af- ter accessing five years worth of Medicare data on eight elective surgical procedures, including knee replacement, hip replace- ment and laparoscopic gallbladder remov- al. ey only analyzed elective procedures since those are scheduled in advance and performed on patients generally in good health. Cases where patients were admit- ted through the emergency room or from nursing homes were omitted. is le the reporters with approxi- mately 2.3 million elective procedures for Medicare fee-for-service patients. ey then consulted a panel of two dozen phy- sicians to determine which complications were appropriate to gauge outcomes. ey counted cases where patients died in the hospital and those where patients were readmitted within 30 days with complica- tions that were most likely surgically-re- lated. Within this sample, overall compli- cation rates looked low on paper — only about 2 to 4 percent, according to Pro- Publica. Yet when 2 to 4 percent is illus- trated in lives, it equates to 3,405 deaths of Medicare patients during a hospital stay and a staggering 63,173 readmissions. e results also showed great varia- tion in performance between surgeons, even at some of the nation's top medical centers. For example, 756 surgeons who performed at least 50 operations did not have one recorded complication. On the other hand, about 25 percent of complica- tions could be attributed to just 11 percent of physicians, according to ProPublica. Imagine you are a passenger on a flight with a pilot who is one of few re- sponsible for one in four plane crashes — that's something you'd want to know before boarding the aircra. While the whole flight crew, the plane and even the weather may have contributed to some or all of those crashes, the pilot is still ulti- mately responsible for everything from takeoff to landing. It's the same drill in the operating room. While a surgeon may not be at fault for a surgical complication, they are ul- timately responsible for them, and that's what the Surgeon Scorecard tries to get at. It's not meant to point fingers or overlook the influence of team-based care. "e surgeon isn't necessarily to blame, but the surgeon is responsible for the overall episode of care," said Mr. Al- len. "e surgeon is best able to figure out what might have gone wrong and best able to prevent it in the future. at's what we are trying to motivate and spur along — the commitment to improvement." e American College of Surgeons and patient safety experts confirmed that surgeons are considered responsible for all aspects of a patient's care, just like a pilot is ultimately responsible for landing safely at the destination. While this idea of holding surgeons responsible for outcomes is an accepted principle, publishing those outcomes on- line is a whole new animal. What report card? We spoke with a handful of surgeons and other medical professionals to get their take on the new tool. Each of the surgeons we spoke with had low adjusted complication rates in at least one proce- dure. ey were also affiliated with orga- nizations that ranked well overall in their region. e scorecard ranks a healthcare organization by its surgeon with the low- est adjusted rate of complications and by the combined performance of surgeons and hospitals under its Medicare ID for those procedures. Everyone we talked to was familiar with the Surgeon Scorecard, but not nec- essarily concerned by it. John Cooper, MD, associate medical director of quality and surgical services at the Palo Alto (Calif.) Medical Foundation, was so impressed by the tool that he wrote in to ProPublica and said he was sharing

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