ACHA Policy Advisory Council March 15, 2013

Public Reporting  Jeffrey Bott, MD, MBA President of the Florida Society of Cardiovascular and Thoracic Surgeons Orlando Regional Medical Center ○ Chairman of Department of Thoracic Surgery Soon to transition from private practice to hospital employed 250 to 300 “open heart” cases/year Database participant Publicly report

Public Reporting  Society of Thoracic Surgeons (STS) Founded in members ○ 1/2 to 2/3 are active (>20 hrs./wk.) adult cardiac surgeons ○ 90% report data to the STS 42% agree to Public Reporting -Consumer Union -STS website “STS believes the public has a right to know the quality of surgical outcomes and considers public reporting an ethical responsibility of the specialty.”

Public Reporting  Database Started in 1989 Housed at Duke Clinical Research Institute Over 4.5 million patients in the database ○ No other database like it in the world Clinical data, not claims 9 page form and 100’s of fields on every patient Uniform definitions ensure accuracy and purity

Public Reporting  Database All participants pay to submit data Risk adjusted Peer reviewed and audited Currently 1071 “practices” reporting ○ 250 publicly report Feedback provided quarterly for all participants

Public Reporting  Methods Online at STS.org Consumer Reports ○ NQF approved metrics 4 Domains + composite -Preoperative -Intraoperative -Post operative complications -Mortality ○ Star ratings (1 – 3)

Public Reporting

 Pro’s Professional and ethical responsibility Robust database without equal ○ Far superior to any administrative claims data ○ Clinically useful ○ Risk adjusted Can draw reliable meaningful conclusions Provides methods for analysis of CQI and Patient Safety initiatives

Public Reporting  Pro’s Consumer choice ○ Transparency ○ Accountability Affirms fundamental ethical right of patient autonomy

Public Reporting  Con’s Cost ○ Money ○ Time Requires expertise ○ Statistics ○ Medical knowledge Errors ○ Few MD’s have the time to audit and correct Most have non-clinical abstractors submitting Now too large for DCRI to do anything but random audits

Public Reporting  Con’s Skewed ○ Good penetrance – over 90% ○ Only 42% Publicly report Hospital level reporting ○ Not reflective of an individual surgeon One exception ○ Multiple MD’s at multiple hospitals Small denominators (sample size)

Public Reporting  Con’s Marketing ○ Costs to system Refusal to care for sicker patients ○ New York #1 problem…….. ○ Nothing to compare surgical outcomes against No data on the medical treatment of patients No data on the percutaneous treatment of patients Need longitudinal studies

Public Reporting  Summary Data allows one to draw meaningful conclusions but is quite complex Affirms patient right to know but will that translate into action (example) Data is robust/reliable but nothing longitudinal for comparison May result in denial of care No mechanism to help those on the left side of the bell curve

Public Reporting  Suggestions Enforce reporting for all programs Consider requiring participation in other databases – ACC, SVS Prepare for substantial costs to get actionable individual level data Will need to educate public Must consider remedial actions for low performers Currently, most likely a tool for professionals