Blog | Tuesday, March 1, 2016

More public reporting


Readers of this blog know that I am a fan of public reporting of performance data. I believe that data transparency helps fulfill an obligation to our patients to be honest about the care we provide, and is also a potent stimulus for improvement. There are obvious conditions that ought to be met before any sort of data—about quality, patient experience, finances or anything else—is shared in this way. The data should be meaningful (pertaining to something that patients are likely to care about), valid (the data actually measure what we say it measures), reliable (vary consistently with performance) and presented in a way that patients can easily make sense of it.

Our own efforts to report the patient satisfaction scores of Northwell Health Physician Partners physicians has been well received by our members and the press because it meets all of these criteria.

Some of the other public reporting efforts, such as recent reporting of surgical complications by Pro Publica, have been criticized for failing to meet the standards of validity and reliability, although I and others have been supportive of their efforts.

A recent report in the Journal of the American College of Cardiology outlines a major new initiative on public reporting of cardiovascular procedural outcomes. A little background first. Years back, the ACC launched the National Cardiovascular Data Registry, or NCDR. As described in the current report, the NCDR consists of a “suite of registries … that collect, audit, benchmark and report clinical data and outcomes on specific cardiovascular procedures and diagnoses to participating institutions.” Up until now, the data collected was shared only with the participating institutions. What is new is that the ACC and collaborating groups have “developed a pathway for participant institutions to voluntarily publicly report their NCDR hospital-level data.” This is big.

It is big because cardiovascular procedures are big—prevalent, high-risk and expensive—and because up until now there have not been easy ways for patients (and providers and payers) to get reliable information about the outcomes of these procedures. Yes, there are several states that have robust reporting of outcomes of percutaneous coronary interventions, but the only outcome typically reported is mortality which, while obviously important, is a very low-frequency event and an insensitive way to distinguish high quality from low quality programs. The NCDR effort has the potential to report a broader array of measures, starting with how often patients receive indicated adjunctive medical therapy, but eventually moving on to “validated quality measures, risk-adjusted clinical outcomes, and composite quality measures across NCDR registries.”

This is also big because the ACC and its partners seem to be doing this the right way. The report is a model for what other professional societies can and should do to provide more and better data on the care we provide.

If we as medical professionals don't take the lead in doing this kind of work, others will, and I think they won't do it as well, and we and our patients will suffer as a result.

What do you think?