NASS supports ‘Surgeon Scorecard’ database, greater health care transparency

The North American Spine Society released a statement in support of ProPublica journalists’ efforts to bring transparency to health care through ProPublica’s “Dollars to Doctors” feature, as well as its newly-released “Surgeon Scorecard” database, which provides complication rates for more than 17,000 U.S. surgeons.

Leadership from the North American Spine Society (NASS) worked with reporters from ProPublica to identify appropriate elective spinal procedures, define complications and offer ongoing risk-adjustment guidance and research for the Surgeon Scorecard project, according to a press release.

Patients should use the scorecard as only one piece of information in making a decision about surgery, according to Charles Mick, MD, a former NASS president.

Complication, death rates listed

“ProPublica utilized a vast Medicare administrative database to stratify physicians and hospitals according to complication rates. They present this complex data in an easy to search, easy to interpret, patient friendly format. Individual, risk-adjusted provider statistics for eight common procedures may be viewed and compared with that of other providers by location and by procedure,” Mick told Spine Surgery Today.

Charles Mick

According to ProPublica, the company gathered complication rates and death rates for surgeons performing one of eight elective procedures in Medicare.

Mick said the project will give patients a tool to gather important information on quality, which they can then use to make informed choices when considering surgical treatment. Patients need to be informed about their condition, and their potential providers, because better-informed patients have better outcomes.

Transparency is encouraged

A larger benefit and goal will be to help shatter the code of silence surrounding complications and encourage a culture of transparency, constructive discussion and continuous quality improvement, according to Mick.

“All medical providers need accurate, meaningful, risk adjusted and timely data on complications and outcomes for the care they provide. This data is needed in order to identify high quality care and care that needs improvement. None of us is perfect. We can all improve. Analysis of administrative data is a start. The next step is to gather and examine clinical data such as that collected by a registry or through individual case reviews. If deficiencies are confirmed and areas for improvement are identified, then changes should be made. Finally review of new/updated data should be performed to document improvement,” Mick told Spine Surgery Today.

Eight elective procedures

The eight elective procedures ProPublica gathered complication and death rates for are posterolateral lumbar spinal fusion, posterior interbody lumbar fusion, anterior cervical fusion (ICD-9-CM 81.07, 81.08 and 81.02, respectively), prostate resection, knee replacement, hip replacement, gallbladder removal (laparoscopic) and prostate removal.

“The validity of a complication database requires careful risk adjustment to accommodate varying case complexity and statistically sufficient numbers. Surgeons with high complication rates often respond that their cases are more difficult. ProPublica chose for this project only common, frequently performed elective procedures to assure sufficient numbers for analysis,” Mick said.

ProPublica also developed a methodology to adjust complication rates to take into account health status, hospital quality and age, according to Mick.

The NASS offers several services and products to aid spine specialists, including evidence-based training and guidelines and appropriate use criteria to define reasonable care of spinal disorders.

May not be enough

The American Academy of Orthopaedic Surgeons (AAOS) also issued a press release on the topic. AAOS president David D. Teuscher, MD, stated that the AAOS supports transparency, but the overall issue is much more complex.

“We also welcome transparency, and certainly a database on the surgical complication rates of a patient population, undergoing specific procedures, provides important information and a potentially useful tool for patients and physicians. However, the totality of the surgical complication issue is much more complex, and cannot be effectively addressed without considering all of the variable that impact surgery, care, and outcomes,” Teuscher stated in the release. – by Robert Linnehan

References:
American Academy of Orthopaedic Surgeons. AAOS Statement on ProPublica Article—Making the cut: Why choosing the right surgeon matters even more than you know. Available at: http://newsroom.aaos.org/media-resources/news/aaosstatmentonpropublicastory.htm. Accessed Aug. 4, 2015.
North American Spine Society. NASS assists and responds to ProPublica’s “Surgeon Scorecard; 2015. Available at: https://www.spine.org/Portals/0/Documents/PressReleases/2015/PressRelease071415.pdf. Accessed July 17, 2015.

For more information:
Charles Mick, MD, can be reached at Pioneer Spine and Sport Physicians, 766 N. King St., #3, Northampton, MA 01060; email: mickch@aol.com.

Disclosure: Mick reports no relevant financial disclosures.