The healthcare environment increasingly
links reimbursements to measurable improvements in clinical outcomes. Some
hospitals are adopting scoring systems to assess doctors with the aim of
inspiring physicians to improve performance and measuring performance. Often
times, these score cards can have the unintentional effect of making surgeons
avoid the sickest patients in an effort to improve their scores, explains The New England Journal of Medicine.
One website for publicly available surgical scores is the online news site Pro Publica. They have scores for over 17,000 surgeons based on eight elective surgeries from information taken from Medicare claims data. Surgeon John Birkmeyer told The New England Journal of Medicine that the scoring system of Pro Publica cannot account for results and complications that don't have anything to do with the surgeon's ability or performance. In addition, there were too few operations in the analysis to create data that is statistically significant.
The risk of score card data is patients can misinterpret it. How patients identified "the best" surgeon depended greatly on the way in which the information was presented, one study found. The most important figure is risk-adjusted mortality, yet most patients only focused on the amount of deaths. This really is deceptive because some hospitals manage more complex and riskier cases that are referred to them by other hospitals that are not able to handle them.
It is not likely that these surgical score cards will go away. Some hospitals and some states are attempting to address this issue in an effort to mitigate physician avoidance of the sickest patients. Massachusetts, for example, is excluding scores for patients that are classified as “exceptional risk” or “compassionate use”. These groups have a much greater danger of surgical complications, which could lower a doctor's score.
To learn more about the complicated issue of physician scoring, contact us.
One website for publicly available surgical scores is the online news site Pro Publica. They have scores for over 17,000 surgeons based on eight elective surgeries from information taken from Medicare claims data. Surgeon John Birkmeyer told The New England Journal of Medicine that the scoring system of Pro Publica cannot account for results and complications that don't have anything to do with the surgeon's ability or performance. In addition, there were too few operations in the analysis to create data that is statistically significant.
The risk of score card data is patients can misinterpret it. How patients identified "the best" surgeon depended greatly on the way in which the information was presented, one study found. The most important figure is risk-adjusted mortality, yet most patients only focused on the amount of deaths. This really is deceptive because some hospitals manage more complex and riskier cases that are referred to them by other hospitals that are not able to handle them.
It is not likely that these surgical score cards will go away. Some hospitals and some states are attempting to address this issue in an effort to mitigate physician avoidance of the sickest patients. Massachusetts, for example, is excluding scores for patients that are classified as “exceptional risk” or “compassionate use”. These groups have a much greater danger of surgical complications, which could lower a doctor's score.
To learn more about the complicated issue of physician scoring, contact us.
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