Disclosing physician-level outcomes data can lead to better patient care, but it's not always welcome news, says former NY exec.
During the time Nirav R. Shah, MD, was New York State Health Commissioner, the state analyzed surgical outcomes data and found that 23% of the coronary angioplasty procedures in the state were being done inappropriately.
"When we said we were going to release the data, the cardiologists, of course, complained—'My patients are sicker … the data is wrong … this will cause fear and confusion for patient … you are doing a great disservice by releasing this data,' "he said.
Nevertheless, the state collected the data, analyzed it, and sent it to the physicians. Within 18 months, the rate of inappropriate procedures dropped from 23% to 8%, said Shah, now senior vice president of Kaiser Permanente's Southern California region.
"All we did was release the data. It changed the culture," he said.
He recounted his experience during a recent seminar titled "Can Transparency Improve Healthcare?" Shah and co-presenter Marshall Allen, a reporter for ProPublica, made the case that using—and reporting—outcomes data to measure physician quality does lead to better care.
"One of the hardest things to do in healthcare and is change physician culture," said Shah. "The power of transparency— even incremental transparency among peers—made a big difference."
ProPublica created the Surgeon Scorecard last year, which uses Medicare data to calculate death and complication rates for surgeons performing one of eight elective procedures, adjusted for differences in patient health, age, and hospital quality.
"The problem is kept secret and the self-policing in the medical industry, generally speaking, just does not work,"Allen said.
Patient Experience: One Person at a Time
Allen and his colleagues expected to find variation in complications rates, but were surprised to find large variations within the same hospital.
Some major players in the medical and patient safety community criticized the investigation, calling it "vigilante"research, but others embraced it, Allen said.
The searchable database went live in the summer of 2015. Since then, it has been used by more than 2 million people, he said.
Shah said smaller hospitals can benefit from transparency, and they might be surprised at the data troves residing on their own servers.
"Look at the readmission rates in your hospital by surgeon. It's probably sitting there with the surgeon's name next to it," he added. "All you have to do is go to a surgical chief meeting and say 'Did you see this Excel spreadsheet?' "