Publicly reported data on outcomes for individual surgeons are controversial and have limitations, but should be reported anyway, according to an August 24, 2017, JAMA Forum article. The author traces publicly reported data on individual surgeons to New York in the 1980s, when newspapers used the Freedom of Information Act to obtain surgeon-level data from the state health department. Objections to such data reporting are worthy of consideration, the author says. For instance, an individual surgeon may perform a low volume of certain procedures, yielding a small sample size that may be an unreliable measure of his or her actual performance. Given that surgeries involve an entire team, reporting outcomes for a surgeon unfairly gives them credit (or blame) for the entire team's work, according to another objection. And if surgeons know that their outcomes will be publicly reported, another fear is that they will avoid the most serious cases to avoid “dragging down" their numbers. Despite these legitimate concerns, the author says, individual surgeon factors are important and patients should have access to this information. For example, the author says, a surgeon's skill at tasks such as cutting, suturing, or dissecting can vary significantly, and this can affect outcomes—information that is useful to patients. Moreover, surgeons vary in their criteria for case selection, and reporting results at an institutional level would fail to show the surgeon's judgment in selecting cases for which surgery is likely to produce a positive outcome. Finally, the author notes, patients increasingly want access to surgeon-specific data so that they can choose providers. That last factor, together with the desire to improve the quality of care, means that surgeon-level data should be publicly available, the author concludes.
HRC Recommends: Risk managers' awareness and support of quality-of-care data collection and reporting are critical because the goals of quality improvement and risk management are congruent. It is imperative that risk managers understand various quality reporting initiatives and that they establish a working relationship with quality improvement, public relations, and clinical departments.