Public Reporting
Jeffrey Bott, MD, MBAPresident of the Florida Society of
Cardiovascular and Thoracic SurgeonsOrlando Regional Medical Center
○ Chairman of Department of Thoracic SurgerySoon to transition from private practice to
hospital employed250 to 300 “open heart” cases/yearDatabase participantPublicly report
Public Reporting Society of Thoracic Surgeons (STS)
Founded in 19646600 members
○ 1/2 to 2/3 are active (>20 hrs./wk.) adult cardiac surgeons
○ 90% report data to the STS42% 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
DatabaseStarted in 1989Housed at Duke Clinical Research InstituteOver 4.5 million patients in the database
○ No other database like it in the worldClinical data, not claims 9 page form and 100’s of fields on every
patientUniform definitions ensure accuracy and
purity
Public Reporting
DatabaseAll participants pay to submit dataRisk adjustedPeer reviewed and auditedCurrently 1071 “practices” reporting
○ 250 publicly reportFeedback provided quarterly for all
participants
Public Reporting
MethodsOnline at STS.orgConsumer Reports
○ NQF approved metrics4 Domains + composite
- Preoperative- Intraoperative- Post operative complications- Mortality
○ Star ratings (1 – 3)
Public Reporting
Pro’sProfessional and ethical responsibilityRobust database without equal
○ Far superior to any administrative claims data○ Clinically useful○ Risk adjusted
Can draw reliable meaningful conclusionsProvides methods for analysis of CQI and
Patient Safety initiatives
Public Reporting
Pro’sConsumer 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 submittingNow too large for DCRI to do anything but random audits
Public Reporting
Con’sSkewed
○ Good penetrance – over 90%○ Only 42% Publicly report
Hospital level reporting○ Not reflective of an individual surgeon
One exception
○ Multiple MD’s at multiple hospitalsSmall denominators (sample size)
Public Reporting
Con’sMarketing
○ Costs to systemRefusal to care for sicker patients
○ New York#1 problem……..
○ Nothing to compare surgical outcomes againstNo data on the medical treatment of patientsNo data on the percutaneous treatment of patientsNeed longitudinal studies
Public Reporting
SummaryData allows one to draw meaningful
conclusions but is quite complexAffirms 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 careNo mechanism to help those on the left side
of the bell curve
Public Reporting
SuggestionsEnforce reporting for all programsConsider requiring participation in other
databases – ACC, SVSPrepare for substantial costs to get
actionable individual level dataWill need to educate publicMust consider remedial actions for low
performersCurrently, most likely a tool for professionals