The Surgeon Scorecard: A Revolution in Medical Transparency or a Paradox?
By Ana Santos
Medicine X brought together ProPublica journalists, surgeons and an ePatient scholar to discuss medical accountability
FRIDAY, Sept. 25 – In July 2015, ProPublica, a non-profit newsroom, published a controversial article that compared the performance of nearly 17 thousand surgeons who do common elective procedures. The analysis was based on Medicare billing data, and informed by ProPublica’s patient safety Facebook group, where the journalists heard from ordinary patients their insights and concerns. On top of that, the editorial team hired Sebastien Haneuse, a professor of biostatistics at the Harvard School of Public Health, to help craft a methodology that would be both useful to patients and fair to surgeons.
Yet, upon publication the ProPublica scorecards received mixed reactions. Today at Medicine X 2015, one of the most remarkable panels ranged around these viewpoints. ProPublica’s Olga Pierce, deputy data editor, and reporter Marshall Allen opened the session by walking the audience through the process of creating the scorecards, and the different methodologies applied to it. “We knew that if what we wanted to report the complication rates to the public there would be serious challenges,” said Pierce. “The first reason is that perfect data does not exist on any field, especially not in Medicine, and in a way that the public can get its hands on.”
The journalists explained that when they started the analysis, surgeons’ identities were encrypted, but early in the process they found as much variation between hospitals as within them—in different departments and, surprisingly, among surgeons. In order to help patients shop for quality health care, they argued, they had to disclose more. “Our stance is very pro-transparency,” Allen remarked, “we believe that patients have the right to know about the quality of care that they receive and they’re paying for.” He argued that “if transparency were a medication, it would be a blockbuster, with billions of dollars in sales and accolades the world over,” citing the National Patient Safety Foundation’s report “Shining a Light.”
Following Pierce and Allen, doctors David Miller and Brian Stork, from the Michigan Urological Surgery Improvement Collaborative (MUSIC), addressed the audience. Miller acknowledged that ProPublica’s release of surgeon scorecards aligns with his beliefs that “we need more systematic initiatives aimed at improving the quality and safety of complex operative procedures.” But instead of criticizing the scorecards, they would rather explain a different model: MUSIC. Stork then relayed his personal experience. In his quest to improve his craft, he longed for better tools to keep records about his surgical outcomes, and also compare it with the results of other surgeons. More than that, he needed help to leverage that data, and turn it into actionable items. MUSIC came about to tackle that challenge. Today, nearly four years later, the group includes 42 practices from across Michigan, representing nearly 85% of the urologists in the state.
Stork shared specific examples of how participating in MUSIC has helped his practice. The group instituted a new antibiotic protocol for patients undergoing prostate biopsy that resulted in over 50% fewer hospitalizations for prostate biopsy-related infection across the state. “Our rates are now some of the lowest reported in the nation,” he added. “I think what’s most important, however, is that by participating in MUSIC, our group has become much more comfortable with active surveillance and careful monitoring of patients.”
But why not publicly report the data collected through MUSIC? “There are mixed feelings among surgeons in the group about the degree to which publicly reporting data has proven benefits in terms of improving outcomes for patients,” said Miller. “I think if we started profiling the surgeons in MUSIC based on the data we have available, we could threaten the engagement and improvement we have achieved over the years. Because, after all, it’s not always about the surgeons who think they have the best outcomes, and are comfortable sharing it. And if we don’t have all the people on the table, then learning from each other in a collaborative way becomes more difficult. We believe that our patients deserve no less,” he concluded.
After Miller and Stork’s remarks, mediator Jordan Shlain, primary care doctor and respected thought leader in national health policy, joined the session along with Dr. Robert Wachter, Professor at the University of California San Francisco medical school, and ePatient scholar Breck Gamel, whose son suffers cystic fibrosis. On the one side, the group debated the potential revolution in medical accountability, since such comprehensive data is being brought to public eyes for the first time. On the other, they largely debated the scorecards as a medium, since opinions diverge on the best methods, measures and the very fact that the data, including surgeon’s names, was disclosed.
Panels like the one seen at Medicine X today play a key role in both clarifying the discussion’s purpose, while fueling its resolve. At the end, both sides agreed that together, patients, surgeons and journalists must create a culture of collaboration and innovation.
Ana is an MA student at Stanford’s data-driven journalism program. She has extensive experience with reporting and corporate communications in her home country of Brazil and in Europe. Find her on Twitter at @anacrochas.