Stop the Blustering About High-risk Patients
"The most dramatic decrease occurred between the fourth quarter of 2005 (3.18%) and the first quarter of 2006 (2.01%)," Romano wrote.
The reports cover all operative mortality during the hospitalization when the CABG was performed and within 30 days after the surgery, regardless of where the patient died.
The second finding comes from two reports that evaluated surgeon specific mortality rates, with specific surgeons identified by name, in July 2007 for 2003-04 and April 2009 for 2005, 06.
Those surgeons identified as having high mortality rates seemed to be performing fewer CABGs than the surgeons who were labeled as having normal patient mortality outcomes.
What seems to be happening is that within hospitals, medical staffs are policing their own, repurposing surgeons with bad outcomes into other types of care.
In fact, in the California report, Romano notes that among the 12 surgeons who had been labeled as having high risk-adjusted mortality, four discontinued performing those surgeries. What's more, the change from the reduction of those surgeons' volume did not account for the dramatic decline in CABG patient mortality.
Disclosure of the information to the public has, in Romano's opinion, fostered a major soul searching among hospitals and providers to do the right thing to get their practices in shape for themselves and their patients.
"The surgeons in the hospital are responding to the information because it's in the public domain more vigorously than they would respond if it weren't in the public domain. It's pride," he says. "There's now a diffusion of best practices. People are learning from each other. People have perhaps gained more experience over time."
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