After getting their sources of revenue scrutinized, physicians' performance is now under public review.
The not-for-profit Consumers' Checkbook/Center for the Study of Services, which previously put out a similar guide to hospitals, released ratings of surgeons. The ratings are based on Medicare fee-for-service data on 14 common major surgeries, including heart-valve replacement and bypass surgery, major bowel surgery, and hip and knee replacement.
Individual surgeons were evaluated based on their risk-adjusted rates of patient deaths, complications (based on prolonged lengths of hospital stays), and readmissions.
In-hospital or 90-day mortality rates for the top 10% heart-and-valve-replacement and bypass surgeons were less than 3%, while the bottom 10% had death rates of more than 11%, according to Consumers' Checkbook's findings.
ProPublica released its Surgeon Scorecard which used Medicare data and focused on eight elective procedures such as hip and knee replacements, gall bladder removal, prostate removal and spinal fusions.
The authors explained that these surgeries were chosen because “they are typically performed on healthy patients and are considered relatively low risk.” They based their evaluations on rates of complications such as infections, blood clots, uncontrolled bleeding and misaligned orthopedic devices.
The ratings were met with both ire and satisfaction.
American Academy of Orthopaedic Surgeons said it was committed to eliminating preventable surgical harm. They took issue with ProPublica's methodology, saying it didn't take into account all of the variables that impact surgery, care and outcomes.
The American Medical Association warned that publishing performance data was subject to "misinterpretations that harm reputations and undermine the trust that patients have in their physicians." But it also noted that there was value in reliable, complete and actionable data.
Blogger Dr. Jen Gunter, an OB/GYN and pain physician, expressed her concern about ProPublica's ratings in her “Wielding the Lasso of Truth” blog warned that the data should distinguish between necessary surgeries and unavoidable complications.
Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said "the timing couldn't be better" for the release of these reports because it raises awareness of the issue and about how "solutions are at our fingertips."
These solutions include many concepts borrowed from the airline industry including checklists, time outs, warm ups and especially simulation.
Wetter said simulation helped save the lives of 155 people when US Airways Capt. Chesley "Sully" Sullenberger landed his plane safely on the Hudson River after birds disabled the engines soon after takeoff on a Jan. 15, 2009 flight.
"His reaction was hardwired into his brain because he had done this over and over in simulation, but he only had to do it once in a lifetime," Wetter said. "Some complications surgeons will only see once in a career. They're like having ducks fly into your engines."
But Wetter also warned that the best surgeons often get the most difficult cases and patients reading performance reports need to realize this.
"You can't compare them the same way you can compare whether cell phones produced in one factory are as good as cell phones produced in another," Wetter said.
