Surgeons' Performances Scored for the First Time

Medical mistakes during and after surgery kill more than a hundred thousand Americans every year and experts say many of those mistakes can be prevented.

Now, post-surgical Medicare data showing surgeons’ performances is being made available for the public to see.

ProPublica, a non-profit news organization in New York, has published five years of data linking 17,075 surgeons nationwide to the outcomes of eight different common elective surgeries the surgeons performed on Medicare patients.

The data looks at the outcomes involving surgeries performed on 64,367 patients.

The analysis allows health care consumers to see how many times patients were readmitted to the hospital within 30 days after those surgeries due to complications.

ProPublica worked with medical professionals from Harvard and Johns Hopkins Medical Schools to create an algorithm which generates an “adjusted complication rate”—a number which measures how likely complications are to occur while adjusting for other risk factors like patient health at the time of operation.

The NBC Bay Area Investigative Unit reviewed the data for California surgeons.

According to the ProPublica data, Sacramento orthopedic surgeon, Dr. Stephen Howell, performed 916 knee replacement surgeries over a five year period on Medicare patients. Only 12 of those resulted in complications, giving Howell a very low adjusted complication rate. According to the ProPublic adjusted complication rates, Dr. Howell performed in the top 3% of California doctors who performed knee replacement surgeries on Medicare patients.

“Everybody is looking to reduce this complication rate,” Dr. Howell told the Investigative Unit, but he credited his team and his hospital’s resources for his low-risk score.

“I think complications are really sort of devastating for the patient and their family and they’re also sort of devastating for the physician,” Dr. Howell said.

Dr. Howell performs up to six knee replacement surgeries each day at Dignity Health’s Methodist Hospital in Sacramento. Over the last two decades, he has focused on improving outcomes and reducing his patients’ readmission rates.

Dr. Howell’s team documented research showing that shorter hospital stays after knee replacement surgery leads to better outcomes and fewer complications.

He says publishing this Medicare outcome data and ProPublica’s analysis of it, benefits the medical community and patients alike.

“I think [the data] is a decent way to make everybody accountable for what we’re doing and try to improve the quality of care our patients receive.”

“When you look at very standardized and elective procedures there is rarely any time when things should go wrong,” Dr. Marty Makary of Johns Hopkins, who advised ProPublica on this project, told NBC News.

“For the first time ever, in a way that’s groundbreaking, we are seeing a plethora of good data inform the performance metrics of doctors and hospitals in a way we can understand,” Dr. Makary said.

Dr. Makary says the data creates a level playing field for doctors and may stimulate competition amongst surgeons to perform better

“In a way, we can say most doctors are doing the right thing and always will do the right thing, but there’s a small fraction that are either responding to perverse incentives or exercising poor skill or judgment and have atrocious outcomes,” Dr. Makary said.

“Ideally, the individual physicians will share these data and say how can we help each other get better,” said Dr. Jay Wolfson with the University of South Florida Medical School. Dr. Wolfson is one of the nation’s leading researchers focused on improving healthcare for consumers and transparency in the medical field.

“These data provide some insight into what we know to be oftentimes the extraordinary variation in process and outcome associated with healthcare. And it let’s all of us to stand back and say what are we doing and how can we do what we do better?” Dr. Wolfson said. But Wolfson warns against misusing the data analysis.

“I think we need to be cautious that we don’t use this as a hammer. When we start using publishable data that we obtain from medical records and we focus on the clinicians we go back to the blame and shame game,” said Wolfson. “We don’t want to do that. We want to say our goal is to have a high quality health care system where we can feel comfortable and confident in the care that we receive the hospitals and the physicians who operate on us.”

The analysis allows patients to see which of these eight procedures are more likely to result in complications. For example, medicare patients receiving cervical neck spinal fusion operations were less likely to experience complications.

As for Dr. Howell, he is proud of his score and hopes others will use the data to improve. “We don’t want complications. We want them out of the hospital where it’s safe and we want them back to life.”

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