Las Vegas Sun

March 20, 2019

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Bringing transparency into the operating room

Imagine the sorts of people you’d want to vet before hiring them for a particular job. You might rely on a friend’s recommendation for a car mechanic or dentist. If you’re on the hunt for a hair stylist, wedding photographer or caterer, you might check Google reviews — and take them with a grain of salt.

But on what basis do you select a surgeon? Do you rely on your primary doctor’s referral, even though it may reflect little more than a tit-for-tat friendship between golfing buddies?

For all the people whose backgrounds we look into, perhaps none — besides a spouse or nanny — is more important than a surgeon (and the track record of the hospital where he or she operates). But for a society that loves grading universities, car tires and microwaves, there is little publicly accessible information about how well surgeons perform.

That may be starting to change, thanks to a three-year project by the nonprofit, independent news organization ProPublica, a newsroom of specialized investigative journalists watching out for the public interest. Among them is Marshall Allen, who previously was the health care reporter at the Las Vegas Sun.

At the Sun, Allen and his numbers-crunching colleague Alex Richards spent two years examining the quality of Las Vegas-area hospitals and exposing medical errors that could have — and should have — been avoided.

At ProPublica, Allen expanded his research concept nationally with the help of a colleague, data expert Olga Pierce. Their research suggests surgeons’ skill levels in the operating room can be assessed by various measures and shared with patient-consumers, offering some basis for deciding whether a particular surgeon is procedurally competent in the operating room.

In this case, Allen and Pierce used Medicare data involving 2.3 million surgeries to build a database of 16,000 surgeons nationwide who perform one or more of the following procedures on otherwise-healthy patients: knee and hip replacements, laparoscopic gallbladder removal, lower-back and neck spinal fusions and removal of some or all of the prostate. The journalists then combed the Medicare data — which did not include patient names — to determine which patients had to return to the hospital within 30 days due to apparent complications related to the surgery. The research model was derived with the help of a professor of biostatistics at the Harvard School of Public Health.

The result: a scorecard of surgeons’ performance in the operating room that reflects their rate of positive or negative outcomes. The database is searchable by name. (Some surgeons may not show up if they seldom perform the selected surgeries through Medicare.) The database also indicates the rate of complications at specific hospitals.

Because there is no easy way for consumers to accurately glean doctors’ skills, Allen’s and Pierce’s work brought both accolades and criticism.

“The ProPublica study is a landmark development in public disclosure of physician-level outcomes,” wrote Nate Freese, analytics director at Grand Rounds, a company that guides consumers to medical specialists.

But Freese cautioned that the scorecard reflected procedural skills but not clinical judgment — including accurate diagnoses and whether a surgery was necessary. (He pointed to a different study that found a third of knee replacements were ill-advised.) And there are concerns the data don’t necessarily reflect the complexity of some cases and that some hospital readmissions weren’t due to a surgical shortcoming.

Still, this is a genuine effort to present to consumers a sense of their surgeon’s operating skills. It shows how data can be collected and examined, and conclusions gleaned. In an industry whose consumers are starved for transparency, this is a positive step.

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