Public reporting Of Cardiac Data

1. ACHA Policy Advisory Council March 15, 2013 Public reporting Of Cardiac Data

2. Public Reporting • Jeffrey Bott, MD, MBA • President of the Florida Society of Cardiovascular and Thoracic Surgeons • Orlando Regional Medical Center • Chairman of Department of Thoracic Surgery • Soon to transition from private practice to hospital employed • 250 to 300 “open heart” cases/year • Database participant • Publicly report

3. Public Reporting • Society of Thoracic Surgeons (STS) • Founded in 1964 • 6600 members • 1/2 to 2/3 are active (>20 hrs./wk.) adult cardiac surgeons • 90% report data to the STS • 42% 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.”

4. Public Reporting • Database • Started in 1989 • Housed at Duke Clinical Research Institute • Over 4.5 million patients in the database • No other database like it in the world • Clinical data, not claims • 9 page form and 100’s of fields on every patient • Uniform definitions ensure accuracy and purity

5. Public Reporting • Database • All participants pay to submit data • Risk adjusted • Peer reviewed and audited • Currently 1071 “practices” reporting • 250 publicly report • Feedback provided quarterly for all participants

6. Public Reporting • Methods • Online at STS.org • Consumer Reports • NQF approved metrics • 4 Domains + composite • Preoperative • Intraoperative • Post operative complications • Mortality • Star ratings (1 – 3)

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10. Public Reporting • Pro’s • Professional and ethical responsibility • Robust database without equal • Far superior to any administrative claims data • Clinically useful • Risk adjusted • Can draw reliable meaningful conclusions • Provides methods for analysis of CQI and Patient Safety initiatives

11. Public Reporting • Pro’s • Consumer choice • Transparency • Accountability • Affirms fundamental ethical right of patient autonomy

12. 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 submitting • Now too large for DCRI to do anything but random audits

13. Public Reporting • Con’s • Skewed • Good penetrance – over 90% • Only 42% Publicly report • Hospital level reporting • Not reflective of an individual surgeon • One exception • Multiple MD’s at multiple hospitals • Small denominators (sample size)

14. Public Reporting • Con’s • Marketing • Costs to system • Refusal to care for sicker patients • New York • #1 problem…….. • Nothing to compare surgical outcomes against • No data on the medical treatment of patients • No data on the percutaneous treatment of patients • Need longitudinal studies

15. Public Reporting • Summary • Data allows one to draw meaningful conclusions but is quite complex • Affirms 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 care • No mechanism to help those on the left side of the bell curve

16. Public Reporting • Suggestions • Enforce reporting for all programs • Consider requiring participation in other databases – ACC, SVS • Prepare for substantial costs to get actionable individual level data • Will need to educate public • Must consider remedial actions for low performers • Currently, most likely a tool for professionals