Surgical Endoscopy

, Volume 33, Issue 7, pp 2043–2049 | Cite as

Public reporting and transparency: a primer on public outcomes reporting

  • John R. RomanelliEmail author
  • Pascal R. Fuchshuber
  • Jonah James Stulberg
  • Rebecca Brewer Kowalski
  • Prashant Sinha
  • Thomas A. Aloia
  • Rocco OrlandoIII
SAGES Quality Outcomes and Safety Review



Healthcare consumers seeking accurate information about where to find quality surgical care face a confusing constellation of rating systems that lack transparency or consistency of opinion. For example, a 2016 report in Health Affairs demonstrated that no hospital was rated as a high performer by all four prominent national ratings systems: Consumer Reports, Leapfrog, Healthgrades and U.S. News & World Report (Austin et al. Health Aff 34:423–430, 2015). Surgeons should have an understanding of the current state of public reporting of quality; hospital ratings and data sources; physician ratings and data sources; and transparency of reporting.


We conducted a non-systematic review of the literature.


Hospital quality ratings remain nebulous and there is not universal opinion on the utility of voluntary participation in ranking systems, leaving the current systems largely opinion-based. Early attempts at physician ranking systems are rudimentary at best and suffer from methodological concerns. Publicly reported metrics should be easily understandable, accessible, clinically relevant, reliable, non-punitive, and shielded from legal discovery. Transparency is increasing within institutions to help align staff to institutional objectives, while specialty specific registries are helping to standardize care pathways and outcomes measures across organizations. Measuring surgical outcomes beyond 30-day morbidity and mortality has been plagued by a lack of understanding on how to create metrics that matter; the four attributes of relevance, scientific soundness, feasibility and comprehensiveness set a high bar for the development of effective and efficient quality measures in surgery.


SAGES, via the Quality, Outcomes, and Safety Committee, is committed to learning how to develop meaningful quality metrics in general surgery and will continue to work in other areas that impact quality, such as opioid prescribing, and surgeon wellness.


Transparency Quality Healthcare reporting Ratings 



The authors would like to specifically acknowledge the work of Erin Schwarz of BSC Management, Inc. and the Society of American Gastrointestinal and Endoscopic Surgeons, as she helped not only to organize this manuscript, but the Committee from which this manuscript came from. The creation of this document would not have been possible without her invaluable assistance.

Compliance of ethical standards


Dr. Stulberg reports consulting with Intuitive Surgical and funded research by National Institutes of Health and Pacira Pharmaceuticals, none of which was relevant to the creation of this manuscript. Drs. Romanelli, Fuchshuber, Kowalski, Sinha, Aloia, and Orlando have no conflicts of interest or financial ties to disclose.


  1. 1.
    Austin JM, Jha AK, Romano PS et al (2015) National hospital ratings systems share few common scores and may generate confusion instead of clarity. Health Aff 34:423–430CrossRefGoogle Scholar
  2. 2.
    Huesch MD, Currid-Hallkett E, Doctor JN (2014) Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012. BMJ Open 4(3):e004417CrossRefGoogle Scholar
  3. 3.
    Dehmer GJ, Drozda JP Jr, Brindis RG, Masoudi FA, Rumsfeld JS, Slattery LE, Oetgen WJ (2014) Public reporting of clinical quality data: an update for cardiovascular specialists. J Am Coll Cardiol 63(13):1239–1245CrossRefGoogle Scholar
  4. 4.
    Sharma K, Metzler I, Chen S, Mayer JE Jr, Meara J (2012) Public reporting of healthcare data: a new frontier in quality improvement. Bull Am Coll Surg 97(6):6–13Google Scholar
  5. 5.
    Consumer Reports. Looking for a heart surgeon? These ratings can help you find a good one.
  6. 6.
    Rechel B, McKee M, Haas M, Marchildon GP, Bousquet F, Blümel M, Geissler A, van Ginneken E, Ashton T, Saunes IS, Anell A, Quentin W, Saltman R, Culler S, Barnes A, Palm W, Nolte E (2016) Public reporting on quality, waiting times and patient experience in 11 high-income countries. Health Policy 120(4):377–383CrossRefGoogle Scholar
  7. 7.
    Aleccia J. (2010) Doctors seek to stifle patients’ rants on Web sites. Accessed 13 January 2010
  8. 8.
    National Quality Forum. Measures Application Partnership. and National Quality Forum. Measures Application Partnership Pre-Rulemaking Report: Public Comment Draft. Accessed 1 July 2018
  9. 9. Physician Compare. Accessed 1 July 2018
  10. 10.
    Cleveland Clinic Quality & Patient Safety Institute. (n.d.). Accessed 1 July 2018
  11. 11.
    Hartford HealthCare Quality, Safety & Value Annual Report. (n.d.) Accessed 1 July 2018
  12. 12.
    Chun J, Bafford AC (2014) History and background of quality measurement. Clin Colon Rectal Surg 27(1):5–9CrossRefGoogle Scholar
  13. 13.
    Brand RA (2009) Ernest Amory Codman MD 1869–1940. Clin Orthop Relat Res 467(11):2763–2765CrossRefGoogle Scholar
  14. 14.
    Zinman D (1991) Heart surgeons rated. State reveals patient-mortality records. Newday. 34–37Google Scholar
  15. 15.
    Schneider EC, Epstein AM (1996) Influence of cardiac-surgery performance reports on referral practices and access to care. A survey of cardiovascular specialists. N Engl J Med 335(4):251–256CrossRefGoogle Scholar
  16. 16.
    Medicine Io (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington, DCGoogle Scholar
  17. 17.
    Friedberg MW, Pronovost PJ, Shahian DM et al. (2015) A Methodological Critique of the ProPublica Surgeon Scorecard. Accessed 22 July 2016
  18. 18.
    Ban KA, Cohen ME, Ko CY et al. (2016) Evaluation of the ProPublica surgeon scorecard “adjusted complication rate” measure specifications. Ann Surg 264:566–574CrossRefGoogle Scholar
  19. 19.
    Marshall C, Romano MN, Davies PS (2004) How do we maximize the impact the impact of the public reporting of quality of care? Int J Qual Health Care 16(1):157–163Google Scholar
  20. 20.
    U.S. (2014) News & World Report Poll: How Do You Choose a Doctor?. Accessed 17 March 2014
  21. 21.
  22. 22.
    Aloia TA, Zimmitti G, Conrad C, Gottumukalla V, Kopetz S, Vauthey JN (2014) Return to intended oncologic treatment (RIOT): a novel metric for evaluating the quality of oncosurgical therapy for malignancy. J Surg Oncol 110(2):107–114CrossRefGoogle Scholar
  23. 23.
    Day RW, Cleeland CS, Wang XS, Fielder S, Calhoun J, Conrad C et al (2015) Patient-reported outcomes accurately measure the value of an enhanced recovery program in liver surgery. J Am Coll Surg 221(6):1023–1030 (e1–e2)CrossRefGoogle Scholar
  24. 24.
    Lee L, Dumitra T, Fiore JF Jr, Mayo NE, Feldman LS (2015) How well are we measuring postoperative “recovery” after abdominal surgery? Qual Life Res 24(11):2583–2590CrossRefGoogle Scholar
  25. 25.
    van der Meij E, van der Ploeg HP, van den Heuvel B, Dwars BJ, Meijerink W, Bonjer HJ et al (2017) Assessing pre- and postoperative activity levels with an accelerometer: a proof of concept study. BMC Surg 17(1):56CrossRefGoogle Scholar
  26. 26.
    Aziz O, Atallah L, Lo B, Elhelw M, Wang L, Yang GZ et al (2007) A pervasive body sensor network for measuring postoperative recovery at home. Surg Innov 14(2):83–90CrossRefGoogle Scholar
  27. 27.
    Edmiston CE, Spencer M, Lewis BD, Brown KR, Rossi PJ, Henen CR et al (2011) Reducing the risk of surgical site infections: did we really think SCIP was going to lead us to the promised land? Surg Infect 12(3):169–177CrossRefGoogle Scholar
  28. 28.
    Cohen ME, Ko CY, Bilimoria KY, Zhou L, Huffman K, Wang X et al (2013) Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 217(2):336–346 (e1)CrossRefGoogle Scholar
  29. 29.
    Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, Bohnert ASB, Kheterpal S, Nallamothu BK (2017) New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 152(6):e170504CrossRefGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons 2019

Authors and Affiliations

  1. 1.Department of SurgeryBaystate Medical CenterSpringfieldUSA
  2. 2.Kaiser PermanenteWalnut CreekUSA
  3. 3.Northwestern Memorial HospitalChicagoUSA
  4. 4.Lenox Hill HospitalNew YorkUSA
  5. 5.NYU Langone Medical CenterNew YorkUSA
  6. 6.The University of Texas MD Anderson Cancer CenterHoustonUSA
  7. 7.Hartford HealthcareHartfordUSA

Personalised recommendations