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ACHA Policy Advisory Council March 15 , 2013. Public reporting Of Cardiac Data. 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
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ACHA Policy Advisory Council March 15, 2013 Public reporting Of Cardiac Data
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
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.”
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
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
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)
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
Public Reporting • Pro’s • Consumer 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 submitting • Now too large for DCRI to do anything but random audits
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)
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
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
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