Preventable medical errors of various kinds kill at least 200,000 Americans each year, making this the third leading cause of death in the United States, six times as many deaths as from auto accidents. One way to reduce such errors is for consumers to choose the best surgeons. For the first time ever, consumers across the U.S. today have access to ratings of individual surgeons based on outcomes—how often their patients die in hospital or within 90 days of hospital discharge, have serious complications in hospital, or need to be readmitted to a hospital within 90 days of discharge.
The ratings were just released by the nonprofit Consumers' Checkbook/Center for the Study of Services and are available at no cost to consumers at www.surgeonratings.org, giving consumers a way to find surgeons likely to have the best results.
These ratings are based on analysis of detailed federal government records, previously not made publicly available, that Consumers' Checkbook was finally able to obtain from the government after years of pushing and suing the government for release. These are records of more than four million major surgeries done by more than 50,000 doctors. Checkbook undertook this project with a goal of greatly reducing patients' risks of bad outcomes from major surgeries.
The new website compares surgeons for 14 of the most important and high-risk types of surgery, including heart valve and bypass surgery, various types of vascular surgery, major bowel surgery, spine surgery, pulmonary surgery, and total knee and hip replacement. The website identifies surgeons with better-than-average performance. There is strong evidence in medical literature that surgeons with better results use better techniques and make sure their patients get better overall care and follow-up in hospital and after release.
For the new website, surgeons' results are adjusted to take into account how frail or sick their patients were. Even after this adjustment, results vary dramatically from surgeon to surgeon. For example—
- For heart valve and bypass surgery, the patients of the best-performing one-tenth of surgeons had death rates of less than 3 percent in-hospital or within 90 days of discharge, compared to death rates of more than 11 percent for patients of the worst-performing one-tenth of surgeons. The average surgeon Checkbook evaluated had about a 6 percent death rate with these surgeries.
- Similarly, for major small and large bowel surgery, death rates ranged from less than 6 percent for the best-performing one-tenth of surgeons to more than 20 percent for the worst-performing one-tenth, with a rate of about 12 percent for the average surgeon.
- And for total hip and knee replacement, where deaths are rare, the best-performing one-tenth of surgeons had overall bad-outcome rates (deaths, complications, and readmissions) of less than 8 percent, while the worst-performing one-tenth had overall bad-outcome rates of more than 21 percent, and the average was about 13 percent.
The site also provides meaningful supporting information about the hospitals top performing surgeons use and how well those hospitals perform, how experienced surgeons are with specific procedures, whether they are recommended by other doctors, and more.
For ten years, Checkbook fought to have the federal government release the Medicare fee-for-service data on which the SurgeonRatings.org ratings are based, including suing for release and winning in Federal District Court in 2006, only to have the ruling overturned when the government and the American Medical Association appealed on grounds of "privacy" rights of the doctors.
"This report is possible now because of policies implemented recently by some forward-thinking government leaders," said Robert Krughoff, Checkbook's president.
"We expect this new website to help many thousands of patients avoid unnecessary deaths and other bad outcomes and to help doctors improve," Krughoff said. "The website has extensive advice for patients on how to make decisions and how to do their part in getting quality care. And it should not only motivate and reward doctors for improvement but also assist them in finding resources to help. We regard this website as a first step, and look forward to continually improving measurement in the future."
Until now, most patients have had to choose surgeons with little information on likely results. A few state governments have published results for individual surgeons for heart valve and bypass surgery and Checkbook's ratings match up well with those state reports. But there have been no such ratings for most types or surgery and none even on heart valve and bypass surgery in most parts of the country.