Public reporting and transparency: a primer on public outcomes reporting
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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.
KeywordsTransparency 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.
- 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.Consumer Reports. Looking for a heart surgeon? These ratings can help you find a good one. http://www.consumerreports.org/health/doctors-hospitals/surgeon-ratings/heart-surgery-ratings/overview/index.htm
- 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.Aleccia J. (2010) Doctors seek to stifle patients’ rants on Web sites. http://www.nbcnews.com/id/34794632/ns/health-health_care/t/docs-seek-stifle-patients-rants-web-sites/#.UdgFFxZjA5Q. Accessed 13 January 2010
- 8.National Quality Forum. Measures Application Partnership. http://www.qualityforum.org/Setting_Priorities/Partnership/Measure_Applications_Partnership.aspx and National Quality Forum. Measures Application Partnership Pre-Rulemaking Report: Public Comment Draft. http://nqf.informz.net/NQF/data/images/map_pre-rulemaking_report_for_comment.pdf. Accessed 1 July 2018
- 9.Medicare.gov. Physician Compare. http://www.medicare.gov/physiciancompare/search.html. Accessed 1 July 2018
- 10.Cleveland Clinic Quality & Patient Safety Institute. (n.d.). https://my.clevelandclinic.org/departments/clinical-transformation/depts/quality-patient-safety. Accessed 1 July 2018
- 11.Hartford HealthCare Quality, Safety & Value Annual Report. (n.d.) https://hartfordhealthcare.org/about-us/annual-reports/hartford-healthcare-quality-safety. Accessed 1 July 2018
- 14.Zinman D (1991) Heart surgeons rated. State reveals patient-mortality records. Newday. 34–37Google Scholar
- 16.Medicine Io (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington, DCGoogle Scholar
- 17.Friedberg MW, Pronovost PJ, Shahian DM et al. (2015) A Methodological Critique of the ProPublica Surgeon Scorecard. http://www.rand.org/pubs/perspectives/PE170.html. Accessed 22 July 2016
- 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.U.S. (2014) News & World Report Poll: How Do You Choose a Doctor?. https://health.usnews.com/health-news/top-doctors/articles/2014/03/14/poll-how-do-you-choose-a-doctor. Accessed 17 March 2014
- 21.Simpson L. https://archive.ahrq.gov/chip/content/monitoring_evaluation/quality_stratagy_choice-chars_of_measures.htm. Accessed 1 July 2018