Logic, Science and Rationale of Public Reporting

By, SAURABH JHA

Public reporting of doctors is fiercely controversial. I’m vehemently opposed to it. So I decided to find out why its proponents favor it.

I discuss public reporting with Ben Harder, Chief of Health Analysis at U.S. News and World Report, for JACR Firing Line. We disagreed for most parts, though we agreed that there are bad ways to rate doctors, and better ways, too. Listen to our discussion here.

Key points made by Ben Harder:

a) Reporting of quality is a decision support tool for patients and their caregivers. It is NOT to penalize or shame doctors but to engage consumers in their healthcare decisions. This is an important distinction.

b) If methods to rate quality are so bad how is it that hospitals which look after the sickest patients also have the highest rating?

c) Newer methods to rate quality make a huge effort not to compare apples (hip surgeons) with oranges (knee surgeons).

d) We are still suffering the legacy of poor risk adjustment.

Key points made by me:

a) The logic of risk-adjustment is backwards. “Adjustment” makes it sound like we’re making the surgeon whole again. Rather, surgeons should be rewarded for taking on the sickest, poorest and most complex patients. Risk adjustment should be an “honor score” – each surgeon/ interventional cardiologist should have a score which is a measure of the complexity of the patient they treat.

b) There are some attributes, which lead to poor outcomes, which can’t be captured systematically. For example, distribution of calcification in the iliac arteries of transplant recipient is very important for transplant surgeons, because it’s the difference between success and failure. For cardiac surgeons, not all infected grafts are the same. Not all re-do sternotomies are the same. Not all revision hips are the same.

c) If public reporting, regardless of its intent, accentuates risk aversion, this is not a good outcome.

Saurabh Jha, aka @RogueRad, is contributing editor to THCB and host of Firing Line Podcast, which are produced by JACR, and sponsored by Healthcare Administrative Partners.

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