The American College of Surgeons strongly believes that patients and their families deserve to have meaningful information available to assist them in selecting the right surgeon. Last week, two public interest groups launched websites promising to assist with surgeon evaluation. Unfortunately, the usefulness of the information they shared is questionable for a number of reasons.
The two groups used differing methodologies, including how many years of Medicare data they reviewed, procedures studied, and rating scales used. A patient who visited both websites could potentially find the same surgeon rated very differently or only find a surgeon on one of the two websites.
Use of clinically validated data would have more fully taken into account the severity of the patient's condition when assessing surgeon performance. For example, an 80-year-old diabetic patient with heart disease undergoing a gall bladder removal faces many more challenges than a healthy 40-year-old undergoing the same operation. Without factoring in surgeons' success rate with the more challenging patients, the potential for wrongly directing patients away from these surgeons certainly increases. And as troubling, some insurers might restrict access to these surgeons in the future.
The importance of relying on clinical data to accurately measure surgeon performance is well documented in scientific literature, and clinical registries are considered the standard for collecting this information. As recently as this year, this point was underscored in a peer-reviewed article by Lawson et al in the Annals of Surgery.*
Collection and dissemination of accurate clinical data, however, is a shared responsibility because it is a labor- and cost-intensive process. Private payors, government, professional societies, and public interest groups—all of whom are invested in transparency—must share this responsibility.
Two other issues bear consideration. First, surgery is a team experience. The surgeon works closely with the anesthesiologist and surgical nurses during an operation. While using clinical data can get us closer to measuring surgical performance, the reality is that in the operating room, many factors and many individuals contribute to the surgical outcome. Rating a surgeon's skill in performing a particular operation, without factoring in these other considerations, leads to an incomplete analysis.
Second, we must ask ourselves how much data is helpful to patient decision? The American College of Surgeons fully supports sharing the right data with the right person at the right time. We are open to collaborating with other stakeholders, including those in the public and private sector to identify the data that will serve the public interest.
At its core, the American College of Surgeons is committed to improving the care of the surgical patient and believes that sharing meaningful data is key to that endeavor. Let's do it right and together.
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