PUBLIC REPORTING OF CARDIAC DATA

ACHA Policy Advisory Council

March 15, 2013

Public Reporting

Jeffrey Bott, MD, MBAPresident of the Florida Society of

Cardiovascular and Thoracic SurgeonsOrlando Regional Medical Center

○ Chairman of Department of Thoracic SurgerySoon to transition from private practice to

hospital employed250 to 300 “open heart” cases/yearDatabase participantPublicly report

Public Reporting Society of Thoracic Surgeons (STS)

Founded in 19646600 members

○ 1/2 to 2/3 are active (>20 hrs./wk.) adult cardiac surgeons

○ 90% report data to the STS42% agree to Public Reporting

- Consumer Union- STS website

“STS believes the public has a right to know the quality of surgical outcomes and considers public reporting an ethical responsibility of the specialty.”

Public Reporting

DatabaseStarted in 1989Housed at Duke Clinical Research InstituteOver 4.5 million patients in the database

○ No other database like it in the worldClinical data, not claims 9 page form and 100’s of fields on every

patientUniform definitions ensure accuracy and

purity

Public Reporting

DatabaseAll participants pay to submit dataRisk adjustedPeer reviewed and auditedCurrently 1071 “practices” reporting

○ 250 publicly reportFeedback provided quarterly for all

participants

Public Reporting

MethodsOnline at STS.orgConsumer Reports

○ NQF approved metrics4 Domains + composite

- Preoperative- Intraoperative- Post operative complications- Mortality

○ Star ratings (1 – 3)

Public Reporting

Public Reporting

Public Reporting

Public Reporting

Pro’sProfessional and ethical responsibilityRobust database without equal

○ Far superior to any administrative claims data○ Clinically useful○ Risk adjusted

Can draw reliable meaningful conclusionsProvides methods for analysis of CQI and

Patient Safety initiatives

Public Reporting

Pro’sConsumer choice

○ Transparency○ Accountability

Affirms fundamental ethical right of patient autonomy

Public Reporting Con’s

Cost○ Money○ Time

Requires expertise○ Statistics○ Medical knowledge

Errors○ Few MD’s have the time to audit and correct

Most have non-clinical abstractors submittingNow too large for DCRI to do anything but random audits

Public Reporting

Con’sSkewed

○ Good penetrance – over 90%○ Only 42% Publicly report

Hospital level reporting○ Not reflective of an individual surgeon

One exception

○ Multiple MD’s at multiple hospitalsSmall denominators (sample size)

Public Reporting

Con’sMarketing

○ Costs to systemRefusal to care for sicker patients

○ New York#1 problem……..

○ Nothing to compare surgical outcomes againstNo data on the medical treatment of patientsNo data on the percutaneous treatment of patientsNeed longitudinal studies

Public Reporting

SummaryData allows one to draw meaningful

conclusions but is quite complexAffirms patient right to know but will that

translate into action (example)Data is robust/reliable but nothing

longitudinal for comparison May result in denial of careNo mechanism to help those on the left side

of the bell curve

Public Reporting

SuggestionsEnforce reporting for all programsConsider requiring participation in other

databases – ACC, SVSPrepare for substantial costs to get

actionable individual level dataWill need to educate publicMust consider remedial actions for low

performersCurrently, most likely a tool for professionals