An analysis of Medicare data for 25,000 surgeons concludes that specialization may be a stronger of measure of quality than volume.
Strong evidence and common sense support the idea that volume is a measure of surgical competency.
A group of academic medical centers have even taken the volume pledge, agreeing not to perform high-risk procedures if they don't have the volume. They encourage others to do the same.
But there has been pushback.
Smaller hospitals wonder whether they'll meet volume thresholds. Others say the possible, unintended consequence of volume rules could lead to consolidation of services and limited access.
Now comes a study suggesting that the link between surgical volume and quality may be more complicated than a function of practice-makes-perfect.
An analysis of Medicare data for 25,000 surgeons concludes that "specialization" may be a stronger of measure of quality than volume.
Volume is measured as the number of times a surgeon performs a procedure. Specialization is defined by researchers as the number of times a surgeon has performed a certain procedure, divided by the number of times a physician has performed any surgical procedure.
While the two measures dovetail, specialization predicts 30-day mortality independent of volume.
John Birkmeyer, MD, of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, NH is one of the study authors. He performed much of the research supporting volume as a quality measure, and is a proponent of the volume pledge.
The new findings do not mean specialization should replace volume as a quality measure, says co-author and Harvard University economist Nikhil Sahni. "We are by no means saying that volume should be replaced by this metric. We are saying that this is a nice metric to have alongside it."
Tinker Ready is a contributing writer at HealthLeaders Media.