'Surgeon scorecard' measures docs by complications

Surgeons around the country are now scored against their peers in a new statistic developed by a non-profit news organization that goes beyond hospital-level data, providing a never-before-available tool for consumers and generating debate and some angst in the surgical community.

Nearly 17,000 doctors performing low-risk, common elective procedures such as gallbladder removal and hip replacements are measured in the new calculation, which the non-profit news outlet ProPublica calls an "Adjusted Complication Rate." The data, derived from government records collected about Medicare patients, is now available online for anyone to search.

"It's long overdue," said Charles Mick, a spine surgeon in Massachusetts who advised on the project. "Consider baseball, if you're a batter but never knew if you hit the pitch, how could know you know if you're getting better?"

Not all surgeons will be happy seeing their names online with a higher-than-average complication rate — based on problems like infections, clots or sepsis that call for post-operative care. But the model also factors various risks a surgeon encounters, and adjusts the complication rates based on patients' ages, the quality of the hospital where the surgery took place, and other factors.

That uncomfortable public exposure is a small price to pay for better patient care, argued Mick, who hoped doctors will use the tool to find hospitals performing with better rates.

Aside from creating better outcomes for patients with better surgeons, the cost of readmissions after surgical complications is staggering. Consider just the hospital bills for Medicare patients: about 66,000 cases of complications that led to additional hospitalization cost taxpayers $645 million between 2009 and 2013. ProPublica's analysis also identified at least 3,400 people who died in the hospital admitted for one of the reviewed elective surgeries.

Last year, the Centers for Medicare and Medicaid Services began docking payments at hospitals that had excessive readmissions in an effort to improve care.

But the first-of-its kind analysis by ProPublica found substantial variation within hospitals. Half of the 3,575 hospitals had a surgeon performing a procedure at which they are high risk — even at elite institutions.

So why do doctors even surrounded by the same staff and high-tech equipment have varying scores?

The analysis and past medical research suggest that complications can depend on genuine doctor skill, a strict adherence to best practices with procedures, volume of surgeries and direct follow-up and personal contact.

It also found an overall low rate of death and readmission across the country — less than 5% for the eight procedures studied.

Monday's distribution of the model opened to uneasy reviews in the medical community, with some physicians skeptical it could capture the vast array of risks involved with the patient population.

Jen Gunter, an obstetrician/gynecologist in San Francisco, wrote on her blog that the model could lead to doctors choosing lower-risk patients to boost their scores.

"What if every surgeon only operated on the good candidates?" Gunter wrote. "People at higher risk for complications will suffer and we will never get surgeons with superior skills."

But Mick, a former president of the North American Spine Society, said the new statistic should be viewed by physicians and hospitals as another tool to improve care.

"I'm hopeful hospitals will look at the data and look for other systems that could work for them," Mick said. "And if you're below average, you can demonstrate how they've improved."

Rocky Bilhartz, a cardiologist in College Station, Texas, said he had concerns about medical transparency becoming a "witch hunt" as opposed to a helpful statistic.

"But I think we are amiss if we think all doctors are equal, they're not," Bilhartz said. "It's much like other professions in society. There are good people who can fix your car and those that can't. But my question is about the cause — and in my experience it's surgeons taking on the most complicated cases."